Early postoperative adherence of matrix-induced autologous chondrocyte implantation for the treatment of full-thickness cartilage defects of the femoral condyle.
Matrix-induced autologous chondrocyte implantation (MACI) is a tissue-engineering technique for the treatment of full-thickness articular cartilage defects and requires the use of a three-dimensional collagen type I-III membrane seeded with cultured autologous chondrocytes. The cell-scaffold construct is implanted in the debrided cartilage defect and fixed only with fibrin glue, with no periosteal cover or further surgical fixation. In a clinical pilot study, the MACI technique was used for the treatment of full-thickness, weight-bearing chondral defects of the femoral condyle in 16 patients. All patients were followed prospectively and the early postoperative attachment rate, 34.7 days (range: 22-47) after the scaffold implantation, was determined. With the use of high-resolution magnetic resonance imaging (MRI), the transplant was graded as completely attached, partially attached, or detached. In 14 of 16 patients (87.5%), a completely-attached graft was found, and the cartilage defect site was totally covered by the implanted scaffold and repair tissue. In one patient (6.25%), a partial attachment occurred with partial filling of the chondral defect. A complete detachment of the graft was found in one patient (6.25%), which resulted in an empty defect site with exposure of the subchondral bone. Interobserver variability for the MRI grading of the transplants showed substantial agreement (kappa=0.775) and perfect agreement (kappa(w)=0.99). In conclusion, the implantation and fixation of a cell-scaffold construct in a deep cartilage defect of the femoral condyle with fibrin glue and with no further surgical fixation leads to a high attachment rate 34.7 days after the implantation, as determined with high resolution MRI.
Marlovits
Stefan
S
Department of Traumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. stefan.marlovits@akh-wien.ac.at
Striessnig
Gabriele
G
Kutscha-Lissberg
Florian
F
Resinger
Christoph
C
Aldrian
Silke M
SM
Vécsei
Vilmos
V
Trattnig
Siegfried
S
D000328:Adult; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D002478:Cells, Cultured; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D005269:Femur / Q000293:injuries / Q000601:surgery*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006085:Graft Survival; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D015915:Motion Therapy, Continuous Passive; D010865:Pilot Projects; D011446:Prospective Studies; D014014:Tissue Adhesives / Q000627:therapeutic use; D023822:Tissue Engineering / Q000379:methods*; D014182:Transplantation, Autologous; D016474:Weight-Bearing
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives