Three-dimensional, Scaffold-Free, Autologous Chondrocyte Transplantation: A Systematic Review

Abstract

Background: A 3-dimensional, scaffold-free, and completely autologous form of chondrocyte transplantation (ACT3D) has been developed and applied in clinical practice in the past decade to overcome disadvantages of previous-generation procedures. Purpose: To document and analyze the available literature on the results of ACT3D in the treatment of articular chondral lesions in the knee and hip joints. Study Design: Systematic review; Level of evidence, 4. Methods: All studies published in English addressing ACT3D were identified and included those that fulfilled the following criteria: (1) level 1 through 4 evidence, (2) measures of radiological or functional/clinical outcome, and (3) outcome related to cartilage lesions of the knee and hip joints. Results: A total of 10 studies were selected: 2 randomized controlled trials, 1 cohort study, and 7 case series. The studies revealed significant increases in patients’ subjective quality of life, satisfaction, pain reduction, and improvement in joint function at short- to medium-term follow-up. Magnetic resonance imaging-assisted examination and second-look arthroscopy showed a hyaline-like repair tissue with a high degree of defect filling and integration. Conclusion: ACT3D shows promising results in the therapy of articular cartilage defects in the knee as well as in the hip, but well-designed, long-term studies are lacking. ACT3D might have relevant advantages over common matrix-associated autologous chondrocyte transplantation products, but systematic evaluation and randomized controlled studies are crucial to verify the potential of this tissue-engineered approach.

Therapie chondraler und osteochondraler Läsionen der Hüfte

“…The culture process involved in 3D-ACI generates redifferentiated autologous chondrocytes along with their extracellular matrix, resulting in scaffold-free 3D spheroids of neocartilage [ 95 , 96 ]. These 3D constructs are injectable solutions, making the second step of chondrocyte implantation similar to injecting scaffolds into the defect site [ 95 ].…”

“…These 3D constructs are injectable solutions, making the second step of chondrocyte implantation similar to injecting scaffolds into the defect site [ 95 ]. Studies evaluating the efficacy of 3D-ACI in the treatment of chondral defects in both the knee and hip have reported promising results [ 96 , 97 ]. These investigations have demonstrated improved patient outcomes, such as increased mHHS and iHOT scores, and successful cartilage healing [ 97 – 99 ].…”

Cell Sources for Cartilage Repair—Biological and Clinical Perspective

“…Although the standard technique requires two procedures and involves arthrotomy, a minimally invasive full-arthroscopic technique has been described as well [ 83 ]. A further modification of the ACI strategies is the use of chondrocytes cultured as small spheroids that are totally autologous without the use of any foreign material and are already in a higher developmental state than chodrocytes in suspension [ 84 , 85 ]. Indications for ACI include larger lesions (4–10 cm 2 ), younger and more active patients.…”

Scaffold-free approaches for the fabrication of engineered articular cartilage tissue

“…Current existing therapies for osteoarthritis treatment include microfracture, autologous chondrocyte implantation (ACI, or autologous chondrocyte transfer), osteochondral autograft transfer (OAT, or mosaicplasty), and total or partial joint replacements [3][4][5]. Total or partial joint replacements are targeted at patients suffering from non-reversible destructive joint disorders and can be devastating.…”