Arthroscopic matrix-associated, injectable autologous chondrocyte transplantation of the hip: significant improvement in patient-related outcome and good transplant quality in MRI assessment

Abstract

Purpose 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. Methods 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. Results 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. Conclusions 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.

Treatment of Large Cartilage Defects in the Knee by Hydrogel-Based Autologous Chondrocyte Implantation: Two-Year Results of a Prospective, Multicenter, Single-Arm Phase III Trial

“…It can be applied either arthroscopically or by a minimally invasive procedure even in difficult defect locations. 16 The cross-linked hydrogel has a water content greater than 95% and does not support cell adhesion for most cell types. However, chondrocytes are anchorage-independent and exhibit high viability as well as a spherical cell morphology in the gel, which promotes and stabilizes their chondrogenic phenotype, 17 , 18 favorable for repair tissue quality and graft survival.…”

Platelet-Rich Plasma Is Not Associated With Improved Outcomes Following Hip Femoroacetabular Impingement Surgery: Very Low-Quality Evidence Suggests Hyaluronic Acid and Cell-Based Therapies May Be Beneficial—A Systematic Review of Biological Treatments

“…Eighteen studies met the inclusion criteria for this review; each was published between 2014 and 2020 from countries which included the United States, Chile, Italy, South Korea, Germany, and Spain. Three studies used PRP 20 , 21 , 22 in conjunction with surgery, 3 used HA as a primary treatment, 23 , 24 , 25 and 12 applied different methods of cell therapies as an adjuvant to surgery for cartilage defects 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ( Table 1 ). Thirteen studies were prospective 20 , 21 , 22 , 23 , 24 , 25 , 26 , 31 , 32 , 35 , 36 , 37 and 5 were retrospective 27 , 28 , 29 , 30 , 33 with 7 of the studies including a control group.…”

“…Three studies used PRP 20 , 21 , 22 in conjunction with surgery, 3 used HA as a primary treatment, 23 , 24 , 25 and 12 applied different methods of cell therapies as an adjuvant to surgery for cartilage defects 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ( Table 1 ). Thirteen studies were prospective 20 , 21 , 22 , 23 , 24 , 25 , 26 , 31 , 32 , 35 , 36 , 37 and 5 were retrospective 27 , 28 , 29 , 30 , 33 with 7 of the studies including a control group. 20 , 21 , 22 , 27 , 29 , 30 , 34 Randomization of patients allocated to treatment or control groups occurred in 3 of these studies.…”

Hip preservation surgery and the acetabular fossa

“…Arthroscopic-assisted autologous chondrocyte transplantation (ACT) is a promising minimally invasive alternative for the treatment of full-thickness chondral injuries in the hip. 73 , 74 Recent experimental studies have used the acetabular fossa for cell-based therapies.…”