Biophysical stimulation improves clinical results of matrix-assisted autologous chondrocyte implantation in the treatment of chondral lesions of the knee
The purpose of the present study was to evaluate the effects of pulsed electromagnetic fields (PEMFs) on clinical outcome in patients who underwent arthroscopic matrix-assisted autologous chondrocyte implantation (MACI) for chondral lesions of the knee.
Thirty patients affected by grade III and IV International Cartilage Repair Society chondral lesions of the knee underwent MACI. After surgery, patients were randomly assigned to either experimental group (PEMFs 4 h per day for 60 days) or control group . Clinical outcome was evaluated through International Knee Documentation Committee (IKDC) subjective knee evaluation form, Visual Analog Scale, Short Form-36 (SF-36) and EuroQoL before surgery and 1, 2, 6, and 60 months postoperative.
Mean size of chondral lesion was 2.4 ± 0.6 cm2 in the PEMFs group and 2.5 ± 0.5 cm2 in the control one. No differences were found between groups at baseline. IKDC score increased in both groups till 6 months, but afterward improvement was observed only in the experimental group with a significant difference between groups at 60 months (p = 0.001). A significant difference between groups was recorded at 60 months for SF-36 (p = 0.006) and EuroQol (p = 0.020). A significant pain reduction was observed in the experimental group at 1-, 2- and 60-month follow-up.
Biophysical stimulation with PEMFs improves clinical outcome after arthroscopic MACI for chondral lesions of the knee in the short- and long-term follow-up. Biophysical stimulation should be considered as an effective tool in order to ameliorate clinical results of regenerative medicine. The use of PEMFs represents an innovative therapeutic approach for the survival of cartilage-engineered constructs and consequently the success of orthopaedic surgery.
Level of evidence
KeywordsOsteochondral lesions Pulsed electromagnetic fields Autologous chondrocyte transplantation Regenerative medicine
Compliance with ethical standards
Conflict of interest
Dr. Matteo Cadossi owns 10% of IGEA SpA shares, the manufacturer of devices used in the present study. All other authors declare not to have any conflict of interest.
There was not outside funding or grants received that assisted in this study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individuals included in the study.
MC and CZ carried out data collection; AS and GL performed the statistical analysis. MC, GL and CZ conceived of the study, and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.
- 1.Ebert JR, Robertson WB, Lloyd DG, Zheng MH, Wood DJ, Ackland T (2010) A prospective, randomized comparison of traditional and accelerated approaches to postoperative rehabilitation following autologous chondrocyte implantation: 2-year clinical outcomes. Cartilage 1:180–187CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Ebert JR, Robertson WB, Woodhouse J, Fallon M, Zheng MH, Ackland T et al (2011) Clinical and magnetic resonance imaging-based outcomes to 5 years after matrix-induced autologous chondrocyte implantation to address articular cartilage defects in the knee. Am J Sports Med 39:753–763CrossRefPubMedGoogle Scholar
- 6.Bosnakovski D, Mizuno M, Kim G, Takagi S, Okumura M, Fujinaga T (2006) Chondrogenic differentiation of bovine bone marrow mesenchymal stem cells (MSCs) in different hydrogels: influence of collagen type II extracellular matrix on MSC chondrogenesis. Biotechnol Bioeng 93:1152–1163CrossRefPubMedGoogle Scholar
- 18.Varani K, Vincenzi F, Ravani A, Pasquini S, Merighi S, Gessi S, et al. (2017) Adenosine receptors as a biological pathway for the anti-inflammatory and beneficial effects of low frequency low energy pulsed electromagnetic fields. Mediat Inflamm 2017. doi: 10.1155/2017/2740963
- 22.Outerbridge RE, Dunlop JA (1975) The problem of chondromalacia patellae. Clin Orthop Relat Res (110):177–196Google Scholar
- 25.International Cartilage Repair Society evaluation package. http://www.cartilage.org/_files/contentmanagement/ICRS_evaluation.pdf
- 27.Cadossi M, Chiarello E, Savarino L, Tedesco G, Baldini N, Faldini C et al (2013) A comparison of hemiarthroplasty with a novel polycarbonate-urethane acetabular component for displaced intracapsular fractures of the femoral neck: a randomised controlled trial in elderly patients. Bone Joint J 95-B(5):609–615CrossRefPubMedGoogle Scholar
- 30.Benazzo F, Zanon G, Pederzini L, Modonesi F, Cardile C, Falez F et al (2008) Effects of biophysical stimulation in patients undergoing arthroscopic reconstruction of anterior cruciate ligament: prospective, randomized and double blind study. Knee Surg Sports Traumatol Arthrosc 16:595–601CrossRefPubMedPubMedCentralGoogle Scholar
- 33.U.S. Food and Drug Administration. http://www.fda.gov/downloads/BiologicsBloodVaccines/CellularGeneTherapyProducts/ApprovedProducts/UCM109339.pdf
- 34.Niethammer TR, Pietschmann MF, Horng A, Rossbach BP, Ficklscherer A, Jansson V et al (2014) Graft hypertrophy of matrix-based autologous chondrocyte implantation: a two-year follow-up study of NOVOCART 3D implantation in the knee. Knee Surg Sports Traumatol Arthrosc 22:1329–1336CrossRefPubMedGoogle Scholar
- 36.Zaslav K, Cole B, Brewster R, DeBerardino T, Farr J, Fowler P et al (2009) A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: results of the study of the treatment of articular repair (STAR) clinical trial. Am J Sports Med 37:42–55CrossRefPubMedGoogle Scholar