Arthroscopic matrix-associated, injectable autologous chondrocyte transplantation of the hip: significant improvement in patient-related outcome and good transplant quality in MRI assessment
- 11 Downloads
Acetabular chondral lesions are common in patients with FAI. For large full-thickness cartilage defects, arthroscopic matrix-associated autologous chondrocyte transplantation (MACT) using an injectable in situ crosslinking product is an option. Aim of the study was to evaluate clinical and MRI results 12 months after MACT of acetabular cartilage defects in FAI patients.
We report data on 21 patients with a focal cartilage defect of the hip [2.97 ± 1.44 cm2 (mean ± SD)] caused by FAI treated with an arthroscopically conducted MACT combined with FAI surgery. The results were assessed with patient-reported outcome measures (iHOT33, EQ-5D) pre- as well as post-operatively and by MRI using MOCART scoring system 6 and 12 months post-operatively.
The iHOT33 score improved from 52.9 ± 21.14 (mean ± SD) pre-operative to 81.08 ± 22.04 (mean ± SD; p = 0.0012) 12 months post-operatively. The lower the pre-operative iHOT33 score and the larger the defect size, the greater the observed improvement compared to pre-operative scores at 12 months. Patients showed a significant improvement in EQ-5D-5L index value (p = 0.0015) and EQ-5D VAS (p = 0.0006). MRI analysis after 12 months revealed a complete integration of the transplant in 16 of 20 patients.
Injectable MACT is a promising minimally invasive treatment option for full-thickness cartilage defects of the hip caused by FAI. A significant improvement in symptoms and function associated with an increase in quality of life was detected in patients treated with injectable MACT combined with FAI surgery. This is of considerable clinical relevance, since, in addition to the elimination of the mechanical cause, MACT allows the successful therapy of consequential cartilage damage.
Level of evidence
Level 4, case series.
KeywordsHip arthroscopy Matrix-associated autologous chondrocyte transplantation MACT Cartilage defect
This study was funded by TETEC Tissue Engineering Technologies AG, Reutlingen, Germany.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved according to the local institutional review board (#EK 48022014) and has been registered by ClinicalTrials.gov (NCT02179346).
- 7.Fickert S, Aurich M, Albrecht D, Angele P, Büchler L, Dienst M, Erggelet C, Fritz J, Gebhart C, Gollwitzer H, Kindler M, Lampert C, Madry H, Möckel G, Niemeyer P, Schröder J, Sobau C, Spahn G, Zinser W, Landgraeber S (2017) Biologische Rekonstruktion lokalisiert vollschichtiger Knorpelschäden des Hüftgelenks: Empfehlungen der Arbeitsgemeinschaft “Klinische Geweberegeneration” der DGOU und des Hüftkomitees der AGA. Z Für Orthop Unfallchirurgie 155:670–682CrossRefGoogle Scholar
- 11.Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120Google Scholar
- 14.Körsmeier K, Claßen T, Kamminga M, Rekowski J, Jäger M, Landgraeber S (2016) Arthroscopic three-dimensional autologous chondrocyte transplantation using spheroids for the treatment of full-thickness cartilage defects of the hip joint. Knee Surg Sports Traumatol Arthrosc 24:2032–2037CrossRefGoogle Scholar
- 15.Krueger DR, Karczewski D, Ballhausen M, Geßlein M, Schütz M, Perka C, Schroeder JH (2017) Is a minimal invasive autologous chondrocyte implantation (ACI) in the hip possible? A feasibility and safety study of arthroscopic treatment of full thickness acetabular cartilage defects with an injectable ACI. Sci Pages Orthop Surg 1(1):1–6Google Scholar
- 16.Lazik A, Körsmeier K, Claßen T, Jäger M, Kamminga M, Kraff O, Lauenstein TC, Theysohn JM, Landgraeber S (2015) 3 T high-resolution and delayed gadolinium enhanced MR imaging of cartilage (dGEMRIC) after autologous chondrocyte transplantation in the hip. J Magn Reson Imaging JMRI 42:624–633CrossRefGoogle Scholar
- 17.Malviya A, Raza A, Jameson S, James P, Reed MR, Partington PF (2015) Complications and survival analyses of hip arthroscopies performed in the national health service in England: a review of 6,395 cases. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 31:836–842CrossRefGoogle Scholar
- 18.Marlovits S, Singer P, Zeller P, Mandl I, Haller J, Trattnig S (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 57:16–23CrossRefGoogle Scholar
- 19.Meyer DC, Beck M, Ellis T, Ganz R, Leunig M (2006) Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res 445:181–185Google Scholar
- 20.Mohtadi NGH, Griffin DR, Pedersen ME, Chan D, Safran MR, Parsons N, Sekiya JK, Kelly BT, Werle JR, Leunig M, McCarthy JC, Martin HD, Byrd JWT, Philippon MJ, Martin RL, Guanche CA, Clohisy JC, Sampson TG, Kocher MS, Larson CM, Multicenter Arthroscopy of the Hip Outcomes Research Network (2012) The Development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the International Hip Outcome Tool (iHOT-33). Arthroscopy 28:595–605 (quiz 606–610.e1)CrossRefGoogle Scholar