Autologous chondrocyte implantation for osteochondral lesions in the knee using a bilayer collagen membrane and bone graft

Abstract

Matrix-induced autologous chondrocyte implantation (MACI) is an established technique used to treat osteochondral lesions in the knee. For larger osteochondral lesions (> 5 cm(2)) deeper than approximately 8 mm we have combined the use of two MACI membranes with impaction grafting of the subchondral bone. We report our results of 14 patients who underwent the 'bilayer collagen membrane' technique (BCMT) with a mean follow-up of 5.2 years (2 to 8). There were 12 men and two women with a mean age of 23.6 years (16 to 40). The mean size of the defect was 7.2 cm(2) (5.2 to 12 cm(2)) and were located on the medial (ten) or lateral (four) femoral condyles. The mean modified Cincinnati knee score improved from 45.1 (22 to 70) pre-operatively to 82.8 (34 to 98) at the most recent review (p < 0.05). The visual analogue pain score improved from 7.3 (4 to 10) to 1.7 (0 to 6) (p < 0.05). Twelve patients were considered to have a good or excellent clinical outcome. One graft failed at six years. The BCMT resulted in excellent functional results and durable repair of large and deep osteochondral lesions without a high incidence of graft-related complications.

Repair of articular cartilage defects by tissue-engineered cartilage constructed with adipose-derived stem cells and acellular cartilaginous matrix in rabbits

“…Cartilage damage caused by trauma, infection, and degenerative diseases can cause long-term joint pain and dysfunction, as well as joint disuse, which causes great pain and discomfort. The traditional cartilage repair methods mainly include subchondral drilling (Mithoefer et al, 2005), microfracture surgery (Takao et al, 2004), and periosteum transplantation (Vijayan et al, 2012). Its purpose is to mobilize a variety of cells to proliferate and differentiate into chondrocyte to achieve the purpose of repair and reconstruction.…”

The state of cartilage regeneration: current and future technologies

“…Long-term outcomes regarding first-generation ACI have demonstrated 71 % survival and 75 % of patients with continued symptomatic improvement at 10 years [26, 27•]. However, this technology requires two procedures and must be combined with grafting in the setting of significant bone loss [28]. Also, there is some concern that outcomes may be negatively affected by prior microfracture at the defect site [10•, 11].…”

Surgical management of osteochondritis dissecans of the knee

“…While not necessary in lesions with a depth of less than 8 mm, ACI can be combined with autologous bone grafting for defects that are deeper than 8-10 mm [68]. Bone grafting can be performed at the time of harvest arthroscopy or during cartilage implantation.…”