Stable clinical long term results after AMIC in the aligned knee

Kaiser, Nadine; Jakob, R. P.; Pagenstert, Geert; Tannast, Moritz; Petek, Daniel

doi:10.1007/s00402-020-03564-7

Cited by 31 publications

(16 citation statements)

References 38 publications

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“…However, since bone marrow appears especially promising judging by the few cases of this study, CartiScaff could be particularly favourable for bone marrow-based one-step procedure (e.g. augmented microfracture), and further improve the already promising results observed in clinical studies [74] .…”

Section: Discussionmentioning

confidence: 74%

Repopulation of decellularised articular cartilage by laser-based matrix engraving

et al. 2021

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Background In spite of advances in the treatment of cartilage defects using cell and scaffold-based therapeutic strategies, the long-term outcome is still not satisfying since clinical scores decline years after treatment. Scaffold materials currently used in clinical settings have shown limitations in providing suitable biomechanical properties and an authentic and protective environment for regenerative cells. To tackle this problem, we developed a scaffold material based on decellularised human articular cartilage. Methods Human articular cartilage matrix was engraved using a CO 2 laser and treated for decellularisation and glycosaminoglycan removal. Characterisation of the resulting scaffold was performed via mechanical testing, DNA and GAG quantification and in vitro cultivation with adipose-derived stromal cells (ASC). Cell vitality, adhesion and chondrogenic differentiation were assessed. An ectopic, unloaded mouse model was used for the assessment of the in vivo performance of the scaffold in combination with ASC and human as well as bovine chondrocytes. The novel scaffold was compared to a commercial collagen type I/III scaffold. Findings Crossed line engravings of the matrix allowed for a most regular and ubiquitous distribution of cells and chemical as well as enzymatic matrix treatment was performed to increase cell adhesion. The biomechanical characteristics of this novel scaffold that we term CartiScaff were found to be superior to those of commercially available materials. Neo-tissue was integrated excellently into the scaffold matrix and new collagen fibres were guided by the laser incisions towards a vertical alignment, a typical feature of native cartilage important for nutrition and biomechanics. In an ectopic, unloaded in vivo model, chondrocytes and mesenchymal stromal cells differentiated within the incisions despite the lack of growth factors and load, indicating a strong chondrogenic microenvironment within the scaffold incisions. Cells, most noticeably bone marrow-derived cells, were able to repopulate the empty chondrocyte lacunae inside the scaffold matrix. Interpretation Due to the better load-bearing, its chondrogenic effect and the ability to guide matrix-deposition, CartiScaff is a promising biomaterial to accelerate rehabilitation and to improve long term clinical success of cartilage defect treatment. Funding Austrian Research Promotion Agency FFG (“CartiScaff” #842455), Lorenz Böhler Fonds (16/13), City of Vienna Competence Team Project Signaltissue (MA23, #18-08)

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Section: Discussionmentioning

confidence: 74%

Repopulation of decellularised articular cartilage by laser-based matrix engraving

et al. 2021

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“…Only 2 cases (14.3%) underwent concomitant corrective surgery with 1 open lateral release and 1 MPFL reconstruction, yet the authors did not specify the anatomy or clinical finding of the patellar instability. Kaiser et al 50 reported stable long-term clinical improvement with a mean Lysholm score of 85 and VAS of 2.3 among the retropatellar subcohort (n = 12) with 1 failure (revision total knee arthroplasty) at a mean follow-up of 9.3 years after AMIC. In this study, all patients with retropatellar AMIC had concomitant corrective surgery for patellar instability with transfer of the tibial tubercle, lateral release and reinforcement of the vastus medialis muscle.…”

Section: Discussionmentioning

confidence: 99%

“…So far, clinical results of AMIC for retropatellar cartilage lesions have only been reported in small case series, studies with short-term follow-up or as a part of studies investigating AMIC for the entire knee joint without thorough subanalysis. [23][24][25][26][27]50 D'Hollander et al 25 reported a case-series of 10 patients after AMIC for PF cartilage lesions with a follow-up of 24 months showing significant clinical improvement. Functional outcomes, however, were lower compared with the current study with a reported mean postoperative Kujula score of 59.8 versus 71.3 and total KOOS of 243.9 versus 343.4.…”

Section: Discussionmentioning

confidence: 99%

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Autologous Matrix-Induced Chondrogenesis (AMIC) for Isolated Retropatellar Cartilage Lesions: Outcome after a Follow-Up of Minimum 2 Years

et al. 2021

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Purpose To evaluate autologous matrix-induced chondrogenesis (AMIC) for isolated focal retropatellar cartilage lesions and the influence of patellofemoral (PF) anatomy on clinical outcomes at a minimum of 2-year follow-up. Methods Twenty-nine consecutive patients (31 knees) who underwent retropatellar AMIC with a mean age of 27.9 ± 11.0 years were evaluated at a follow-up averaging 4.1 ± 1.9 years (range, 2-8 years). Patient factors, lesion morphology, and patient-reported outcome measures, including Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner, Kujula score, and visual analogue scale (VAS) score were collected. PF anatomy was assessed on pre- and postoperative imaging, and subsequently correlated to outcome scores and failure to determine risk factors for poor outcome. Results At final follow-up, the AMIC graft failed in 4 cases (12.9%) at a mean follow-up of 21 ± 14.1 months. Patients with failed grafts had a significantly smaller patellar and Laurins’s PF angle than patients whose graft did not fail ( P = 0.008 and P = 0.004, respectively). Concomitant corrective surgery for patellar instability was performed in 29 knees (93.5%). Grafts that did not fail presented with an average Kujala score of 71.3 ± 16.9, KOOS Pain of 76.2 ± 16.6 and Tegner scores of 4.2 ± 1.8. The patellar angle was significantly associated with the patient’s satisfaction level ( r = 0.615; P < 0.001). Conclusion AMIC for retropatellar cartilage lesions in combination with concomitant corrective surgery for patellar instability results in low failure rate with satisfactory clinical outcome and patient satisfaction of almost 80% at mid-term follow-up. As most failures occurred in patients without concurrent tibial tubercle osteotomy and both a smaller patellar and Laurins’s PF angle were associated with less favorable outcome, this study supports the growing evidence for the need of unloading retropatellar cartilage repair, when indicated. Level of Evidence Case series; level of evidence, 4.

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“…Traumatic injuries and degenerative changes of the knee joint are the most common cause of disability among all ages, causing reduced quality of life (QoL) [1,2]. Therefore, improving patient's QoL and symptoms are key objectives for surgery to treat knee disorders [3][4][5][6][7][8]. As a result, numerous injury-specific rating scales have been utilized in an attempt to enable the assessment of patient's health status, associated knee impairments and treatment effects [9].…”

Section: Introductionmentioning

confidence: 99%

The subjective knee value is a valid single-item survey to assess knee function in common knee disorders

Plachel

Jung

Bartek

et al. 2021

Arch Orthop Trauma Surg

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Introduction The patient’s perspective plays a key role in judging the effect of knee disorders on physical function. We have introduced the Subjective Knee Value (SKV) to simplify the evaluation of individual’s knee function by providing one simple question. The purpose of this prospective study was to validate the SKV with accepted multiple-item knee surveys across patients with orthopaedic knee disorders. Materials and methods Between January through March 2020, consecutive patients (n = 160; mean age 51 ± 18 years, range from 18 to 85 years, 54% women) attending the outpatient clinic for knee complaints caused by osteoarthritis (n = 69), meniscal lesion (n = 45), tear of the anterior cruciate ligament (n = 23) and focal chondral defect (n = 23) were invited to complete a knee-specific survey including the SKV along with the Knee Injury Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee subjective knee form (IKDC-S). The Pearson correlation coefficient was used to evaluate external validity between the SKV and each patient-reported outcome measure (PROM) separately. Furthermore, patient’s compliance was assessed by comparing responding rates. Results Overall, the SKV highly correlated with both the KOOS (R = 0.758, p < 0.05) and the IKDC-S (R = 0.802, p < 0.05). This was also demonstrated across all investigated diagnosis- and demographic-specific (gender, age) subgroups (range 0.509–0.936). No relevant floor/ceiling effects were noticed. The responding rate for the SKV (96%) was significantly higher when compared with those for the KOOS (81%) and the IKDC-S (83%) (p < 0.05). Conclusion At baseline, the SKV exhibits acceptable validity across all investigated knee-specific PROMs in a broad patient population with a wide array of knee disorders. The simplified survey format without compromising the precision to evaluate individual’s knee function justifies implementation in daily clinical practice. Level of evidence II, cohort study (diagnosis).

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Stable clinical long term results after AMIC in the aligned knee

Cited by 31 publications

References 38 publications

Repopulation of decellularised articular cartilage by laser-based matrix engraving

Repopulation of decellularised articular cartilage by laser-based matrix engraving

Autologous Matrix-Induced Chondrogenesis (AMIC) for Isolated Retropatellar Cartilage Lesions: Outcome after a Follow-Up of Minimum 2 Years

The subjective knee value is a valid single-item survey to assess knee function in common knee disorders

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