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Gel Based Autologous Chondrocyte Implantation: The Surgical Technique

Deepak Goyal, Vishvas Modi

Volume 4 | Issue 1 | Jan – April 2019 | Page 27- 33


Author: Deepak Goyal[1], Vishvas Modi[1]

Saumya Arthroscopy & Sports Knee Clinic,
Ahmedabad, India.

Address of Correspondence
Dr (Prof) Deepak Goyal
Saumya Arthroscopy & Sports Knee Clinic,
Ahmedabad, India.
Email: deepak@knee.in


Abstract

Autologous chondrocyte implantation (ACI) is one such technique that has the ability to provide a hyaline (like) repair of the localized cartilage lesions, even when they are of a big size. However, the procedure must be chosen very wisely because of its stringent indications and contraindications. Decision to do ACI procedure is very crucial and the surgeon must come to the decision after a detailed clinic-radiological examination. Gel based ACI is one such technique that allows a 3-dimensional distribution of the autologous cultured chondrocytes in a scaffold that is made of fibrin glue. The technique takes away the common complications that were associated with 1st and 2nd generation ACI; like graft hypertrophy, poor access to the lesion, membrane suturing, monolayer distribution etc. The purpose of this paper is to discuss the indications, contraindications, decision making and preoperative planning for the gel based autologous chondrocyte implantation technique in detail along with the surgical procedure, postoperative rehabilitation and the possible complications.


References

1. Ossendorf C, Kaps C, Kreuz PC, Burmester GR, Sittinger M, Erggelet C. Treatment of posttraumatic and focal osteoarthritic cartilage defects of the knee with autologous polymer-based three-dimensional chondrocyte grafts: 2-year clinical results. Arthritis Res Ther. 2007;9(2):R41.
2. Oussedik S, Tsitskaris K, Parker D. Treatment of articular cartilage lesions of the knee by microfracture or autologous chondrocyte implantation: a systematic review. Arthroscopy. 2015;31(4):732-744.
3. Goyal D, Keyhani S, Lee EH, Hui JHP. Evidence-Based Status of Microfracture Technique: A Systematic Review of Level I and II Studies. Arthroscopy. 2013;29(9):1579-1588.
4. Bark S, Riepenhof H, Gille J. AMIC Cartilage Repair in a Professional Soccer Player. Case Rep Orthop. 2012;2012:364342.
5. Gille J, Behrens P, Schulz AP, Oheim R, Kienast B. Matrix-Associated Autologous Chondrocyte Implantation: A Clinical Follow-Up at 15 Years. Cartilage. 2016;7(4):309-315.
6. Minas T, Ogura T, Bryant T. Autologous Chondrocyte Implantation. JBJS Essent Surg Tech. 2016;6(2):e24.
7. Bartlett W, Skinner JA, Gooding CR, et al. Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br. 2005;87(5):640-645.
8. Behrens P, Bitter T, Kurz B, Russlies M. Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)–5-year follow-up. Knee. 2006;13(3):194-202.
9. Pavesio A, Abatangelo G, Borrione A, et al. Hyaluronan-based scaffolds (Hyalograft C) in the treatment of knee cartilage defects: preliminary clinical findings. Novartis Found Symp. 2003;249:203-217; discussion 229-233, 234-238, 239-241.
10. Schneider U, Rackwitz L, Andereya S, et al. A prospective multicenter study on the outcome of type I collagen hydrogel-based autologous chondrocyte implantation (CaReS) for the repair of articular cartilage defects in the knee. Am J Sports Med. 2011;39(12):2558-2565.
11. Niemeyer P, Albrecht D, Andereya S, et al. Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: A guideline by the working group “Clinical Tissue Regeneration” of the German Society of Orthopaedics and Trauma (DGOU). Knee. 2016;23(3):426-435.
12. Goyal D, Goyal A, Adachi N. Subchondral Bone: Healthy Soil for the Healthy Cartilage. In: Gobbi A, Espregueira-Mendes J, Lane JG, Karahan M, eds. Bio-Orthopaedics. Berlin, Heidelberg: Springer Berlin Heidelberg; 2017:479-486.
13. Cole BJ, Corpus KT, Bajaj S, et al. Prospective Evaluation of Autologous Chondrocyte Implantation Procedure: Minimum Seven-Year Follow-Up (SS-26). Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2011;27(5):e43-e44.
14. Goyal D, Goyal A, Keyhani S, Lee EH, Hui JHP. Evidence-based status of second- and third-generation autologous chondrocyte implantation over first generation: a systematic review of level I and II studies. Arthroscopy. 2013;29(11):1872-1878.
15. Goyal D, Keyhani S, Goyal A, Lee EH, Hui JHP, Vaziri AS. Evidence-Based Status of Osteochondral Cylinder Transfer Techniques: A Systematic Review of Level I and II Studies. Arthroscopy. 2014;30(4):497-505.
16. Pietschmann MF, Horng A, Niethammer T, et al. Cell quality affects clinical outcome after MACI procedure for cartilage injury of the knee. Knee Surg Sports Traumatol Arthrosc. 2009;17(11):1305-1311.
17. Vanlauwe J, Saris DBF, Victor J, et al. Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: early treatment matters. Am J Sports Med. 2011;39(12):2566-2574.
18. Gillogly SD, Myers TH, Reinold MM. Treatment of full-thickness chondral defects in the knee with autologous chondrocyte implantation. J Orthop Sports Phys Ther. 2006;36(10):751-764.
19. Hamby TS, Gillogly SD, Peterson L. Treatment of patellofemoralarticular cartilage injuries with autologous chondrocyte implantation. Operative Techniques in Sports Medicine. 2002;10(3):129-135.
20. Rosenberg TD, Paulos LE, Parker RD, Coward DB, Scott SM. The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am. 1988;70(10):1479-1483.
21. Zbojniewicz AM, Laor T. Imaging of osteochondritis dissecans. Clin Sports Med. 2014;33(2):221-250.
22. Karim AR, Cherian JJ, Jauregui JJ, Pierce T, Mont MA. Osteonecrosis of the knee: review. Ann Transl Med. 2015;3(1):6.
23. Houpt JB, Pritzker KP, Alpert B, Greyson ND, Gross AE. Natural history of spontaneous osteonecrosis of the knee (SONK): a review. Semin Arthritis Rheum. 1983;13(2):212-227.
24. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494-502.
25. Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039-1049.
26. Spector TD, Hart DJ, Byrne J, Harris PA, Dacre JE, Doyle DV. Definition of osteoarthritis of the knee for epidemiological studies. Ann Rheum Dis. 1993;52(11):790-794.
27. Goyal D, Goyal A, Adachi N. Joint Preservation Surgery for Medial Compartment Osteoarthritis. Arthrosc Tech. 2017;6(3):e717-e728.
28. Recht MP, Resnick D. Magnetic resonance imaging of articular cartilage: an overview. Top Magn Reson Imaging. 1998;9(6):328-336.
29. De Smet AA, Fisher DR, Graf BK, Lange RH. Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects. AJR Am J Roentgenol. 1990;155(3):549-553.
30. Lecouvet FE, van de Berg BC, Maldague BE, et al. Early irreversible osteonecrosis versus transient lesions of the femoral condyles: prognostic value of subchondral bone and marrow changes on MR imaging. AJR Am J Roentgenol. 1998;170(1):71-77.
31. Mont MA, Baumgarten KM, Rifai A, Bluemke DA, Jones LC, Hungerford DS. Atraumatic osteonecrosis of the knee. J Bone Joint Surg Am. 2000;82(9):1279-1290.
32. Björkengren AG, AlRowaih A, Lindstrand A, Wingstrand H, Thorngren KG, Pettersson H. Spontaneous osteonecrosis of the knee: value of MR imaging in determining prognosis. AJR Am J Roentgenol. 1990;154(2):331-336.
33. Healy WL. Osteonecrosis of the knee detected only by magnetic resonance imaging. Orthopedics. 1991;14(6):703-704.
34. Goyal D, Goyal A, Brittberg M. Consideration of religious sentiments while selecting a biological product for knee arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2013;21(7):1577-1586.
35. Goyal D, Palkhiwala B. Cover Image. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2013;29(3):A9.
36. Goyal D. The overlay ACI technique for extra-large osteochondral lesions of the knee joint. 2nd Congress of Asian Cartilage Repair Society at Seoul, Korea, 2014.
37. Choi N-Y, Kim B-W, Yeo W-J, et al. Gel-type autologous chondrocyte (Chondron) implantation for treatment of articular cartilage defects of the knee. BMC Musculoskelet Disord. 2010;11:103.
38. Gillogly SD, Voight M, Blackburn T. Treatment of articular cartilage defects of the knee with autologous chondrocyte implantation. J Orthop Sports Phys Ther. 1998;28(4):241-251.
39. Reinold MM, Wilk KE, Dugas JR, Cain EL, Gillogly SD. Rehabilitation Guidelines: Autologous Chondrocyte Implantation Using Carticel. Cambridge, MA: Genzyme Biosurgery; 2004.
40. Reinold MM, Wilk KE, Macrina LC, Dugas JR, Cain EL. Current concepts in the rehabilitation following articular cartilage repair procedures in the knee. J Orthop Sports Phys Ther. 2006;36(10):774-794.
41. Peterson L, Minas T, Brittberg M, Nilsson A, Sjögren-Jansson E, Lindahl A. Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res. 2000;(374):212-234.
42. Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A. Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med. 2002;30(1):2-12.
43. Peterson L, Vasiliadis HS, Brittberg M, Lindahl A. Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med. 2010;38(6):1117-1124.
44. Pareek A, Carey JL, Reardon PJ, Peterson L, Stuart MJ, Krych AJ. Long-Term Outcomes after Autologous Chondrocyte Implantation: A Systematic Review at Mean Follow-Up of 11.4 Years. Cartilage. 2016;7(4):298-308.
45. Kim MK, Choi SW, Kim SR, Oh IS, Won MH. Autologous chondrocyte implantation in the knee using fibrin. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):528-534.
46. Wood JJ, Malek MA, Frassica FJ, et al. Autologous cultured chondrocytes: adverse events reported to the United States Food and Drug Administration. J Bone Joint Surg Am. 2006;88(3):503-507.
47. Niemeyer P, Pestka JM, Kreuz PC, et al. Characteristic complications after autologous chondrocyte implantation for cartilage defects of the knee joint. Am J Sports Med. 2008;36(11):2091-2099.


How to Cite this article: Goyal & Modi. Gel Based Autologous Chondrocyte Implantation: The Surgical Technique. Asian Journal Arthroscopy. Jan-April 2019;4(1):27-33 .


(Abstract)      (Full Text HTML)      (Download PDF)


Scaffold based Autologous Chondrocyte Implantation: The Surgical Technique

Professor Mats Brittberg

Volume 4 | Issue 1 | Jan – April 2019 | Page 23- 26


Author: Professor Mats Brittberg[1]

[1] Cartilage Research Unit, University of Gothenburg, Region Halland Orthopaedics, Kungsbacka Hospital, S-434 80 Kungsbacka Sweden.

Address of Correspondence
Professor- Mats Brittberg
Cartilage Research Unit, University of Gothenburg, Region Halland Orthopaedics, Kungsbacka Hospital, S-434 80 Kungsbacka Sweden.
Email: Mats.brittberg@telia.com


Abstract

Autologous chondrocyte implantation (ACI) has been used clinically since 1987. Most reports on ACI are on the first and second generation ACI with cells in suspension under a sutured membrane and performed with open surgery. Today’s 3rd and 4th generation ACI with cells seeded and grown in or on scaffolds prior to implantation opens up for transarthroscopic implantations. Transarthroscopic surgery reduces the morbidity for the patients and also fastens up the rehab process. In this paper, techniques used for scaffold-based ACI are presented.


References

1.Brittberg M, Lindahl A, Nilsson A et al.Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. New England Journal of Medicine 1994; 331:889-895.
2.Brittberg M.Cartilage repair. On cartilaginous tissue engineering with the emphasis on chondrocyte transplantation. Thesis. University of Gothenburg.1996.
3.Brittberg M. Cell carriers as the next generation of cell therapy for cartilage repair: a review of the matrix-induced autologous chondrocyte implantation procedure.Am J Sports Med. 2010; Jun;38(6):1259-71.
4.Steinwachs M. New technique for cell-seeded collagen-matrix-supported autologous chondrocyte transplantation. Arthroscopy. 2009; Feb;25(2):208-11.
5.Hendriks JA, Moroni L, Riesle et al. The effect of scaffold-cell entrapment capacity and physico-chemical properties on cartilage regeneration. Biomaterials. 2013 Jun;34(17):4259-65
6.de Windt TS, Vonk LA, Slaper-Cortenbach ICM, Nizak R, van Rijen MHP, Saris DBF. Allogeneic MSCs and Recycled Autologous Chondrons Mixed in a One-Stage Cartilage Cell Transplantion: A First-in-Man Trial in 35 PatientsStem Cells. 2017 Aug;35(8):1984-1993
7.Brittberg M. Cartilage fragment implantation. . In Cartilage Surgery. An operative manual. Eds Brittberg M, Gersoff W. Elsevier Saunders Philadelphia,2011; 181-191.
8.Brittberg M, Concaro S. Transarthroscopic implantation of Hyalograft (Hyaff 11) with autologous chondrocytes. In Cartilage Surgery. An operative manual. Eds Brittberg M, Gersoff W. Elsevier Saunders Philadelphia,2011; 147-160.
9. Nehrer S, Dorotka R, Domayer S et al. Treatment of full-thickness chondral defects with hyalograft C in the knee: a prospective clinical case series with 2 to 7 years’ follow-up. Am J Sports Med. 2009; Nov;37 Suppl 1:81S-87S
10.Vascellari A, Rebuzzi E, Schiavetti et al. Implantation of matrix-induced autologous chondrocyte (MACI(®)) grafts using carbon dioxide insufflation arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2014 Jan;22(1):219-25.
11.Marcacci M, Berruto M, Brocchetta D et al. Articular cartilage engineering with Hyalograft C: 3-year clinical results. Clin Orthop Relat Res.2005; Jun;(435):96-105
12.Della Villa S, Kon E, Filardo G et al. Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes? Am J Sports Med. 2010; Jan;38(1):68-77.


How to Cite this article: Brittberg M. Scaffold based autologous chondrocyte implantation: The surgical technique. Asian Journal Arthroscopy. Jan-April 2019;4(1):23-26 .


(Abstract)      (Full Text HTML)      (Download PDF)