Cell Viability in Arthroscopic Versus Open Autologous Chondrocyte Implantation.
BACKGROUND
Autologous chondrocyte implantation (ACI) is an effective method of repair of articular cartilage defects. It is a 2-stage operation, with the second stage most commonly performed via mini-arthrotomy. Arthroscopic ACI is gaining popularity, as it is less invasive and may accelerate early rehabilitation. However, handling and manipulation of the implant have been shown to cause chondrocyte cell death.


OBJECTIVE
To assess the number and viability of cells delivered via an open versus arthroscopic approach in ACI surgery.


METHODS
Controlled laboratory study.


METHODS
Sixteen ACI surgeries were performed on young cadaveric knees by 2 experienced surgeons: 8 via mini-arthrotomy and 8 arthroscopically. Live and dead cells were stained and counted on implants after surgery. The cell number and viability were assessed using confocal laser scanning microscopy. Surgery was timed from knife to skin until the end of cycling the knee 10 times after implantation of the cell-membrane construct.


RESULTS
On receipt of cell membranes after transportation from the laboratory, ≥92% of the cells were viable. There were significantly more remaining cells (8.47E+07 arthroscopic vs 1.41E+08 open; P < .001) and 16 times more viable cells (3.62% arthroscopic vs 37.34% open; P < .001) on the implants when they were inserted via mini-open surgery compared with the arthroscopic technique. Open surgery was of a significantly shorter duration (6 vs 32 minutes; P < .001).


CONCLUSIONS
In this study, there were significantly more viable cells on the implant when ACI was performed via mini-arthrotomy compared with an arthroscopic technique.


CONCLUSIONS
The viability of cells delivered for ACI via an arthroscopic approach was 16 times less than via an open approach. The mini-arthrotomy approach is recommended until long-term clinical comparative data are available.
Royal Infirmary of Edinburgh, University of Edinburgh Medical School, Edinburgh, UK.
Leela C
LC
Biant
University of Edinburgh, Edinburgh, UK.
Michiel
M
Simons
University of Edinburgh, Edinburgh, UK.
Trudi
T
Gillespie
Aintree University Hospital, Liverpool, UK.
Michael J
MJ
McNicholas
D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D064592:Autografts / Q000637:transplantation; D002102:Cadaver; D002358:Cartilage, Articular / Q000601:surgery; D002452:Cell Count; D002470:Cell Survival; D019902:Chondrocytes / Q000637:transplantation*; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008875:Middle Aged; D014182:Transplantation, Autologous / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
articular cartilage resurfacing; knee; tissue engineering