Third-generation autologous chondrocyte implantation after failed bone marrow stimulation leads to inferior clinical results

Abstract

Purpose Third-generation autologous chondrocyte implantation (ACI) is an established and frequently used method and successful method for the treatment of full-thickness cartilage defects in the knee. There are also an increasing number of patients with autologous chondrocyte implantation as a second-line therapy that is used after failed bone marrow stimulation in the patient's history. The purpose of this study is to investigate the effect of previous bone marrow stimulation on subsequent autologous chondrocyte implantation therapy. In this study, the clinical results after the matrix-based autologous chondrocyte implantation in the knee in a follow-up over 3 years postoperatively were analysed. Methods Forty patients were included in this study. A total of 20 patients with cartilage defects of the knee were treated with third-generation autologous chondrocyte implantation (Novocart® 3D) as first-line therapy. The mean defect size was 5.4 cm 2 (SD 2.6). IKDC subjective score and VAS were used for clinical evaluation after 6, 12, 24 and 36 months postoperatively. The results of these patients were compared with 20 matched patients with autologous chondrocyte implantation as second-line therapy. Matched pair analysis was performed by numbers of treated defects, defect location, defect size, gender, age and BMI. Results Both the first-line (Group I) and second-line group (Group II) showed significantly better clinical results in IKDC score and VAS score in the follow-up over 3 years compared with the preoperative findings. In addition, Group I showed significantly better results in the IKDC and VAS during the whole postoperative follow-up after 6, 12, 24 and 36 months compared to Group II with second-line autologous chondrocyte implantation (IKDC 6 months p = 0.015, 1 year p = 0.001, 2 years p = 0.001, 3 years p = 0.011). Additionally, we found a lower failure rate in Group I. No revision surgery was performed in Group I. The failure rate in the second-line Group II was 30%. Conclusion This study showed that third-generation autologous chondrocyte implantation is a suitable method for the treatment of full-thickness cartilage defects. Both, Group I and Group II showed significant improvement in our follow-up. However, in comparing the results of the two groups, autologous chondrocyte implantation after failed bone marrow stimulation leads to worse clinical results. Level of evidence III

Mechanotransduction and Stiffness-Sensing: Mechanisms and Opportunities to Control Multiple Molecular Aspects of Cell Phenotype as a Design Cornerstone of Cell-Instructive Biomaterials for Articular Cartilage Repair

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“…59 In a study comparing primary Novocart 3D to Novocart 3D for revision after failed MST in large cartilage defects (mean 5.4 cm 2 ), Müller et al demonstrated significantly improved clinical outcome scores in both groups, although with significantly better outcomes in the primary group. 60 There were no revision surgeries in the primary Novocart 3D group, while the revision group had a 30% reoperation rate.…”

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“… NOVOCART® 3D ( Table 1 ) is a type I/III collagen biphasic scaffold. The trial by Müller et al [ 59 ] confirmed that the IKDC score and visual analog scale (VAS) score at 6, 12, 24, and 36 months after NOVOCART® 3D implantation were significantly better than those preoperation. In addition, compared with the patients who received NOVOCART® 3D treatment after the failure of bone marrow stimulation, those who received NOVOCART® 3D as the first choice had significantly better postoperative IKDC and VAS results, and the operation failure rate was lower.…”