Cartilage repair surgery prevents progression of knee degeneration

Abstract

Purpose To investigate, whether cartilage repair surgery for focal osteochondral defects at the knee results in less degenerative changes over 6 years in a MR imaging follow-up than morphologically initially identical defects in non-operated control subjects from the osteoarthritis initiative (OAI). Methods A total of 32 individuals received baseline and follow-up MRI. In n = 16 patients with cartilage repair [osteochondral autograft transfer system (OATS), n = 12; spongiosa-augmented matrix-associated autologous chondrocyte implantation (MACI), n = 4] MRI was performed preoperatively and after 5.7 ± 2.3 year follow-up. Baseline MRIs of non-operated subjects from the OAI were screened for initially identical cartilage defects (n = 16). Morphological knee abnormalities were assessed using WORMS, AMADEUS and MOCART scores. A sagittal 2D MSME sequence was implemented for quantitative cartilage T2 relaxation time measurements in all (0, 2, 4, 6 and 8-years) follow-ups from the OAI and in the postoperative MRI protocol. Results For both groups, focal osteochondral defects were located at the femoral condyle in 8/16 cases (5 medial, 3 lateral) and at the patella in 8/16 cases. At baseline, the mean cartilage defect size ± SD was 1.4 ± 1.3 cm 2 for the control group and 1.3 ± 1.2 cm 2 for the cartilage repair group (n.s.). WORMS scores were not significantly different between the cartilage repair group and the control group at baseline [mean difference ± SEM (95%CI); 0.5 ± 2.5 (− 4.7, 5.7), n.s.]. During identical followup times, the progression of total WORMS scores [19.9 ± 2.3 (15.0, 24.9), P < 0.001] and of cartilage defects scores in the affected (P < 0.001) and in the opposing (P = 0.029) compartment was significantly more severe in non-operated individuals (P < 0.05). In non-operated subjects, T2 values increased continuously from baseline to the 8-year follow-up (P = 0.001). Conclusions Patients with cartilage repair showed less progression of degenerative MRI changes at 6-year follow-up than a control cohort from the OAI with initially identical osteochondral defects. Patients with focal cartilage defects may profit from cartilage repair surgery since it may prevent progression of early osteoarthritis at the knee joint. Level of evidence Prognostic study, Level II.

Desktop-stereolithography 3D printing of a radially oriented extracellular matrix/mesenchymal stem cell exosome bioink for osteochondral defect regeneration

“…Articular cartilage damage is regarded as a significant cause for early OA in adolescents and young adults 2. The implantation of a scaffold or cartilage repair surgery represents a good choice after failure of conservative treatment for early OA patients 3, 4. Under normal nutritional conditions, there is a dynamic balance of anabolic and catabolic activities of chondrocytes, which mainly depend on glycolysis to supply their basic energy requirements 5.…”

Trends in the Surgical Treatment of Articular Cartilage Lesions in the United States from 2007 to 2016

“…5 In contrast to microfracture, restoration procedures produce cartilage that more closely resembles natural hyaline cartilage. 7 These newer generation techniques have been shown to provide durable cartilage restoration, slow the progression of degenerative joint changes, and result in high return rates to preinjury level of play. 789 Despite this, in an analysis from 2004 to 2011, McCormick et al showed that palliative procedures were the most commonly utilized cartilage procedures in the United States during that time interval.…”

Recent advances and future trends in articular cartilage repair

“…The current review of various techniques and studies revealed encouraging results. Jungmann et al [3] (2019) did a prognostic Level II study comparing the progression of osteoarthritis in 16 patients treated with cartilage repair surgery for the focal chondral defects (osteochondral autograft transplant system [OATS] n = 12; membrane based autologous chondrocyte implantation [MACI], n = 4) with similar non-operated 16 subjects from osteoarthritis initiative study group having identical cartilage defects. The chondral defects in both the groups were equally distributed at the femoral condyles (n = 8) and the patella (n = 8) and the mean defect size was 1.4 cm 2 (SD ± 1.3) and 1.3 cm 2 (SD ± 1.2) for the control and the cartilage repair groups, respectively.…”