Prospective clinical study of autologous chondrocyte implantation and correlation with MRI at three and 12 months

Abstract

In order to determine the usefulness of MRI in assessing autologous chondrocyte implantation (ACI) the first 57 patients (81 chondral lesions) with a 12-month review were evaluated clinically and with specialised MRI at three and 12 months. Improvement 12 months after operation was found subjectively (37.6 to 51.9) and in knee function levels (from 85% International Cartilage Repair Society (ICRS) III/IV to 61% I/II). The International Knee Documentation Committee (IKDC) scores showed an initial deterioration at three months (56% IKDC A/B) but marked improvement at 12 months (88% A/B). The MRI at three months showed 82% of patients with at least 50% defect fill, 59% with a normal or nearly normal signal at repair sites, 71% with a mild or no effusion and 80% with a mild or no underlying bone-marrow oedema. These improved at 12 months to 93%, 93%, 94% and 91%, respectively. The overall MR score at 12 months suggested production of normal or nearly normal cartilage in 82%, corresponding to a subjective improvement in 81% of patients and 88% IKDC A/B scores. Second-look surgery and biopsies in 15 patients (22 lesions) showed a moderate correlation of MRI with visual scoring; 70% of biopsies showed hyaline and hyaline-like cartilage. Thus, MRI at 12 months is a reasonable non-invasive means of assessment of ACI.

Clinical and cost-effectiveness of autologous chondrocyte implantation for cartilage defects in knee joints: systematic review and economic evaluation

“…Different trials give different results for the proportion who get hyaline after ACI, with higher proportions in the trial by Bentley and colleagues 64 and in the case series reported by Henderson and colleagues 75 than in the trial by Horas and colleagues. 65 If one assumes that hyaline cartilage is the desired outcome, on the basis that hyaline cartilage can last for life (most people do not need knee replacements in their lifetime), then ACI becomes the best option (in clinical effectiveness terms) because it gives the highest chance of the defect being filled with hyaline cartilage.…”

“…In a series of 135 patients from Melbourne treated with ACI, 22 required further surgery, in most cases due to problems with the periosteal cap. 75 Since the intention is always the same -to repair the damaged area with hyaline cartilage -the end result may be the same, but costs may differ.…”

Impact of human platelet lysate on the expansion and chondrogenic capacity of cultured human chondrocytes for cartilage cell therapy

“…In brief, autologous chondrocytes are harvested by arthroscopy from a lesser weight-bearing area of the joint, expanded in monolayer culture and re-implanted into the damaged area under a natural or synthetic membrane by an open joint surgical procedure (Brittberg et al, 1994). Robert Jones & Agnes Hunt (RJAH) Hospital, Oswestry and others report a high percentage of good to excellent clinical results (Bhosale et al, 2009;Henderson et al, 2003). Although there is limited long-term follow-up data, especially from the modern methods of ACI, positive clinical results are beginning to emerge.…”

In SituCrosslinking Elastin-Like Polypeptide Gels for Application to Articular Cartilage Repair in a Goat Osteochondral Defect Model*

“…MRI imaging was performed on a 7.1 T horizontal-bore instrument (Oxford Magnet, Oxfordshire, United Kingdom) to acquire 2D coronal images of the goat knee joints (256 × 256 matrix size, 6 × 6 cm FOV, 1.5 mm slice thickness, TR = 500 ms, TE = minimum, flip angle = 60°, eight averages). Images were graded by three blinded readers according to a scale with features of signal, defect fill, and bone edema (adapted from Henderson et al 36 ) as well as features of surface integrity and contour and cartilage thickness (adapted from Marlovits et al 37 ). The scale was adapted to allow for representation of features from both of the referenced grading schemes used previously, and a four-category ranking was used for each feature for consistency across schemes (0–3, 3 = nondegenerate cartilage).…”