title: A prospective multicenter study on the outcome of type I collagen hydrogel-based autologous chondrocyte implantation (CaReS) for the repair of articular cartilage defects in the knee.
abstract: BACKGROUND
  The Cartilage Regeneration System (CaReS) is a novel matrix-associated autologous chondrocyte implantation (ACI) technique for the treatment of chondral and osteochondral lesions (Outerbridge grades III and IV). For this technology, no expansion of the chondrocytes in a monolayer culture is needed, and a homogeneous cell distribution within the gel is guaranteed.
  
  
  OBJECTIVE
  To report a prospective multicenter study of matrix-associated ACI of the knee using a new type I collagen hydrogel (CaReS).
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  From 2003 to 2008, 116 patients (49 women and 67 men; mean age, 32.5 ± 8.9 years) had CaReS implantation of the knee in 9 different centers. On the basis of the International Cartilage Repair Society (ICRS) Cartilage Injury Evaluation Package 2000, the International Knee Documentation Committee (IKDC) score, pain score (visual analog scale [VAS]), SF-36 score, overall treatment satisfaction and the IKDC functional status were evaluated. Patient follow-up was performed at 3, 6, and 12 months after surgery and annually thereafter. Mean follow-up was 30.2 ± 17.4 months (range, 12-60 months). There were 67 defects of the medial condyle, 14 of the lateral, 22 of the patella/trochlea, and 3 of the tibial plateau, and 10 patients had 2 lesions. The mean defect size was 5.4 ± 2.4 cm(2). Thirty percent of the defects were <4 cm(2) and 70% were >4 cm(2).
  
  
  RESULTS
  The IKDC score improved significantly from 42.4 ± 13.8 preoperatively to 70.5 ± 18.7 (P < .001) at latest follow-up. Global pain level significantly decreased (P < .001) from 6.7 ± 2.2 preoperatively to 3.2 ± 3.1 at latest follow-up. There also was a significant increase of both components of the SF-36 score. The overall treatment satisfaction was judged as very good or good in 88% by the surgeon and 80% by the patient. The IKDC functional knee status was grade I in 23.4%, II in 56.3%, III in 17.2%, and IV in 3.1% of the patients.
  
  
  CONCLUSIONS
  Matrix-associated ACI employing the CaReS technology for the treatment of chondral or osteochondral defects of the knee is a safe and clinically effective treatment that yields significant functional improvement and improvement in pain level. However, further investigation is necessary to determine the long-term viability and clinical outcome of this procedure.
authors: Arthro Nova Clinic, Ringsee, Germany. uschneider@arthronovaclinic.de
authors: Ulrich
authors: U
authors: Schneider
authors: Lars
authors: L
authors: Rackwitz
authors: Stefan
authors: S
authors: Andereya
authors: Sebastian
authors: S
authors: Siebenlist
authors: Florian
authors: F
authors: Fensky
authors: Johannes
authors: J
authors: Reichert
authors: Ingo
authors: I
authors: Löer
authors: Thomas
authors: T
authors: Barthel
authors: Maximilian
authors: M
authors: Rudert
authors: Ulrich
authors: U
authors: Nöth
mesh_terms: D000328:Adult; D054544:Arthroplasty, Subchondral / Q000009:adverse effects / Q000379:methods*; D019902:Chondrocytes / Q000637:transplantation*; D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D020100:Hydrogels / Q000627:therapeutic use*; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D010149:Postoperative Pain; D017060:Patient Satisfaction; D011446:Prospective Studies; D012720:Severity of Illness Index; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D020100:Hydrogels; D003094:Collagen