The aim of our study was to test the hypothesis that in early follow up after matrix guided autologous chondrocyte implantation (MACI), clinical results do not correlate with radiological and histological results, and that MACI as first line procedure and treatment of traumatic cartilage defects leads to better results compared to second line treatment and treatment of degenerative defects. Six and twelve months after MACI, patients IKDC-score was analysed, as well as the results of MRI-examinations. Specimens of the scaffold were histologically assessed at the time of implantation. The IKDC-score as well as the MRI-score improved significantly during follow up. The number of morphological abnormal cells was correlated with a poor clinical outcome. Defect aetiology proved to be a decisive factor for good clinical outcome. Patients with a short history of trauma (<1 year) and an osteochondritis dissecans were found to have better scores 1 year after MACI than patients with a trauma more than 1 year ago. Defect-size, patients age and -gender did not significantly influence the clinical outcome. No differences were seen when MACI was used as first- or second-line procedure. Defect aetiology and quality of the cells are decisive for the clinical outcome. MACI can produce good and very good clinical results even when used as second-line procedure.
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Bartlett W, Skinner JA, Gooding CR et al (2005) Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 87–5:640–645
Behrens P, Bitter T, Kurz B et al (2006) Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)–5-year follow-up. Knee 13:194–202. doi:10.1016/j.knee.2006.02.012
Briggs TW, Mahroof S, David LA et al (2003) Histological evaluation of chondral defects after autologous chondrocyte implantation of the knee. J Bone Joint Surg Br 85:1077–1083. doi:10.1302/0301-620X.85B7.13672
Brittberg M, Lindahl A, Nilsson A et al (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331:889–895. doi:10.1056/NEJM199410063311401
Browne JE, Anderson AF, Arciero R, et al. (2005) Clinical outcome of autologous chondrocyte implantation at 5 years in US subjects. Clin Orthop Relat Res 237–245. doi:10.1097/00003086-200507000-00036
Buckwalter JA, Mankin HJ (1998) Articular cartilage: degeneration and osteoarthritis, repair, regeneration, and transplantation. Instr Course Lect 47:487–504
Cherubino P, Grassi FA, Bulgheroni P et al (2003) Autologous chondrocyte implantation using a bilayer collagen membrane: a preliminary report. J Orthop Surg (Hong Kong) 11:10–15
Erggelet C, Sittinger M, Lahm A (2003) The arthroscopic implantation of autologous chondrocytes for the treatment of full-thickness cartilage defects of the knee joint. Arthroscopy 19:108–110. doi:10.1053/jars.2003.50025
Gilbert JE (1998) Current treatment options for the restoration of articular cartilage. Am J Knee Surg 11:42–46
Hangody L, Fules P (2003) Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am 85-A(Suppl 2):25–32
Hunziker EB (2002) Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects. Osteoarthr Cartil 10:432–463. doi:10.1053/joca.2002.0801
Knutsen G, Engebretsen L, Ludvigsen TC et al (2004) Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 86-A:455–464
Kreuz PC, Steinwachs MR, Erggelet C et al (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil 14:1119–1125. doi:10.1016/j.joca.2006.05.003
Mandelbaum B, Browne JE, Fu F et al (2007) Treatment outcomes of autologous chondrocyte implantation for full-thickness articular cartilage defects of the trochlea. Am J Sports Med 35:915–921. doi:10.1177/0363546507299528
Marcacci M, Berruto M, Brocchetta D et al (2005) Articular cartilage engineering with Hyalograft C: 3-year clinical results. Clin Orthop Relat Res 435:96–105. doi:10.1097/01.blo.0000165737.87628.5b
Marcacci M, Kon E, Zaffagnini S et al (2007) Arthroscopic second generation autologous chondrocyte implantation. Knee Surg Sports Traumatol Arthrosc 15:610–619. doi:10.1007/s00167-006-0265-9
Marlovits S, Singer P, Zeller P et al (2006) Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: determination of interobserver variability and correlation to clinical outcome after 2 years. Eur J Radiol 57:16–23. doi:10.1016/j.ejrad.2005.08.007
Marlovits S, Striessnig G, Resinger CT et al (2004) Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging. Eur J Radiol 52:310–319. doi:10.1016/j.ejrad.2004.03.014
Micheli LJ, Browne JE, Erggelet C et al (2001) Autologous chondrocyte implantation of the knee: multicenter experience and minimum 3-year follow-up. Clin J Sport Med 11:223–228. doi:10.1097/00042752-200110000-00003
Nehrer S, Domayer S, Dorotka R et al (2006) Three-year clinical outcome after chondrocyte transplantation using a hyaluronan matrix for cartilage repair. Eur J Radiol 57:3–8. doi:10.1016/j.ejrad.2005.08.005
Ochs BG, Muller-Horvat C, Rolauffs B et al (2007) Treatment of osteochondritis dissecans of the knee: one-step procedure with bone grafting and matrix-supported autologous chondrocyte transplantation. Z Orthop Unfall 145:146–151. doi:10.1055/s-2007-965167
Ossendorf C, Kaps C, Kreuz PC et al (2007) 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 9:R41. doi:10.1186/ar2180
Peterson L, Brittberg M, Kiviranta I et al (2002) Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med 30:2–12
Peterson L, Minas T, Brittberg M et al (2003) Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg Am 85-A(Suppl 2):17–24
Romeo AA, Cole BJ, Mazzocca AD et al (2002) Autologous chondrocyte repair of an articular defect in the humeral head. Arthroscopy 18:925–929. doi:10.1053/jars.2002.36144
Steadman JR, Briggs KK, Rodrigo JJ et al (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484. doi:10.1053/jars.2003.50112
Trattnig S, Mamisch TC, Welsch GH et al (2007) Quantitative T2 mapping of matrix-associated autologous chondrocyte transplantation at 3 Tesla: an in vivo cross-sectional study. Invest Radiol 42:442–448. doi:10.1097/01.rli.0000262088.67368.49
Trattnig S, Marlovits S, Gebetsroither S et al (2007) Three-dimensional delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) for in vivo evaluation of reparative cartilage after matrix-associated autologous chondrocyte transplantation at 3.0T: Preliminary results. J Magn Reson Imaging 26:974–982. doi:10.1002/jmri.21091
Trattnig S, Millington SA, Szomolanyi P et al (2007) MR imaging of osteochondral grafts and autologous chondrocyte implantation. Eur Radiol 17:103–118. doi:10.1007/s00330-006-0333-z
Watanabe A, Wada Y, Obata T et al (2006) Delayed gadolinium-enhanced MR to determine glycosaminoglycan concentration in reparative cartilage after autologous chondrocyte implantation: preliminary results. Radiology 239:201–208. doi:10.1148/radiol.2383050173
Whittaker JP, Smith G, Makwana N et al (2005) Early results of autologous chondrocyte implantation in the talus. J Bone Joint Surg Br 87:179–183. doi:10.1302/0301-620X.87B2.15376
Zengerink M, Szerb I, Hangody L et al (2006) Current concepts: treatment of osteochondral ankle defects. Foot Ankle Clin 11:331–359. doi:10.1016/j.fcl.2006.03.008
We thank Prof. Mehdi Shakibaei from the Department of Anatomy I (Ludwig Maximilians University) in Munich for his help to process and interpret the light microscopic and Transmission Electron Microscopic samples.
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Pietschmann, M.F., 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 17, 1305–1311 (2009). https://doi.org/10.1007/s00167-009-0828-7