title: Cell-Laden and Cell-Free Matrix-Induced Chondrogenesis versus Microfracture for the Treatment of Articular Cartilage Defects: A Histological and Biomechanical Study in Sheep.
abstract: OBJECTIVE
  The aim of this study was to evaluate the regenerative potential of cell-laden and cell-free collagen matrices in comparison to microfracture treatment applied to full-thickness chondral defects in an ovine model.
  
  
  METHODS
  Animals (n = 30) were randomized into 5 treatment groups, and 7-mm full-cartilage-thickness defects were set at the trochlea and medial condyle of both knee joints and treated as follows: 2 scaffolds in comparison (collagen I/III, Chondro-Gide(®); collagen II, Chondrocell(®)) for covering microfractured defects (autologous matrix-induced chondrogenesis), both scaffolds colonized in vitro with autologous chondrocytes (matrix-associated chondrocyte transplantation), or scaffold-free microfracture technique. One year after surgery, cartilage lesions were biomechanically (indentation test), histologically (O'Driscoll score), and immunohistochemically (collagen type I and II staining) evaluated.
  
  
  RESULTS
  All treatment groups of the animal model induced more repair tissue and showed better histological scores and biomechanical properties compared to controls. The average thickness of the repair tissue was significantly greater when a scaffold was used, especially the collagen I/III membrane. However, none of the index procedures surpassed the others from a biomechanical point of view or based on the histological scoring. Collagen type II expression was better in condylar defects compared to the trochlea, especially in those treated with collagen I/III membranes.
  
  
  CONCLUSIONS
  Covering of defects with suitable matrices promotes repair tissue formation and is suggested to be a promising treatment option for cartilage defects. However, it failed to improve the biomechanical and histological properties of regenerated articular cartilage compared to microfracture alone in an ovine model under the given circumstances.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University of Schleswig-Holstein, Campus Lübeck, Germany.
authors.forename: Justus
authors.initials: J
authors.lastname: Gille
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University of Schleswig-Holstein, Campus Lübeck, Germany.
authors.forename: Julius
authors.initials: J
authors.lastname: Kunow
authors.affiliation: Institute of Anatomy, University of Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Luer
authors.initials: L
authors.lastname: Boisch
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University of Schleswig-Holstein, Campus Lübeck, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Behrens
authors.affiliation: Institute of Pathology, University of Schleswig-Holstein, Campus Lübeck, Germany.
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Bos
authors.affiliation: Institute of Anatomy, University of Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Hoffmann
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University of Schleswig-Holstein, Campus Lübeck, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Köller
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University of Schleswig-Holstein, Campus Lübeck, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Russlies
authors.affiliation: Institute of Anatomy, University of Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Bodo
authors.initials: B
authors.lastname: Kurz
keywords: AMIC; MACT; cartilage repair; microfracture; ovine model