The operative treatment of full thickness cartilage defects in the knee joint with autologous chondrocyte transplantation.
OBJECTIVE
The high clinical and socio-economical impact of cartilage defects and chondral degeneration is well-known. After trauma or without a known etiology, often young patients suffer from pain and a loss of function leading into a decrease of physical activity and, more severe, into long term disability and unemployment. The clinical use of autologous chondrocyte transplantation was introduced in 1994 reporting the data of a pilot study. The objective of this study is to evaluate the efficacy of this method of surgery.


METHODS
Autologous chondrocyte transplantation has been established in our department since 1995 for the treatment of large, full thickness cartilage defects which can be completely covered with hyaline-like cartilage without harming the subchondral bone plate. Our first patients (n=24) all showed Grade IV lesions and an average defect size of 6.27 cm2. All but 4 of the patients had at least 1 cartilage defect related operation on the knee.


RESULTS
The patients and the clinicians rating indicated an increase of a modified Cincinnati Knee score from 3.6 point pre-operation to 6.9 points after 6 months and 8.1 points at 12 months on a scale from 1 (bad) to 10 (excellent). These results support the data of an international multicenter study with almost 2000 patients. The 5 year results described by the originate authors are good to excellent in 85%-95% with an adverse event rate of 5%.


CONCLUSIONS
Autologous chondrocyte transplantation has to be considered a safe and effective method for the treatment of large full thickness cartilage defects. Alternative treatments are symptomatical: drilling, abrasion, lavage, chondroplasty, or osteotomies. The short term results are promising but a lot of patients have to be treated for osteoarthritis as a consequence of failure with total joint arthroplasty. Osteochondral transplantations have the disadvantage of limited harvesting sites and the impairment of the subchondral bone plate.
Erggelet
C
C
Orthopedic Department, University of Freiburg, Hugstetter Str.55 D-79106, Freiburg, Germany. erggelet@ch11.ukl.uni-freiburg.de
Steinwachs
M R
MR
Reichelt
A
A
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D001706:Biopsy; D002357:Cartilage Diseases / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002358:Cartilage, Articular / Q000293:injuries* / Q000601:surgery*; D019902:Chondrocytes / Q000637:transplantation*; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010865:Pilot Projects; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D013524:Surgical Flaps; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome