title: Good clinical and MRI outcome after arthroscopic autologous chondrocyte implantation for cartilage repair in the knee.
abstract: OBJECTIVE
  To analyze the clinical outcome and cartilage regeneration after all-arthroscopic Autologous Chondrocyte Implantation (ACI) using chondrospheres® (ACT3D) for the treatment of full-size articular cartilage lesions at the knee.
  
  
  METHODS
  Thirty consecutive patients treated by all-arthroscopic ACI for full-size articular cartilage lesions in an otherwise healthy knee were enrolled. The defects were located on the femoral condyles (n = 18), in the trochlea (n = 7) and at the patella (n = 5). Follow-up consisted of a clinical evaluation with assessment of subjective scores. Patient satisfaction was evaluated on a visual analog scale (VAS). 3-Tesla MRI and T2 mapping of the operated and the contralateral healthy knees were included to control the quality of the regenerated cartilage. The MOCART score was assessed by three blinded independent radiologists.
  
  
  RESULTS
  At the mean follow-up of 3 years ± 10.2 months 26 of the 30 patients (86.6%) were subjectively highly satisfied with the surgical result and assured they would undergo the same procedure again. The mean Lysholm score increased to 77.7 ± 14.6, the mean subjective IKDC significantly to 84.2 ± 5.6 (p < 0.05) and all five subgroups of the KOOS improved significantly (p < 0.05). The subjective outcome was not influenced by the duration of symptoms, age, location, size of defects nor dose of spheroids. The modified MOCART score was a mean of 60 ± 21 (0-80) points. Twenty-four patients (82.7%) were rated higher than 60 points. T2 mapping documented similar cartilage quality of the area of the ACI and the same location at the contralateral knee. Three patients had a MOCART score of 0 with few or no cartilage regeneration on MRI and were considered as failure of the ACI.
  
  
  CONCLUSIONS
  In this small cohort of 30 patients, minimal invasive all-arthroscopic ACT 3D using spheroids led to convincing clinical short-to-mid-term results with a significant increase in patients quality of life, satisfaction, reduction of pain, and improvement in knee function. The high morphologic integrity and quality of the ACI was reconfirmed by the Mocart Score and T2 mapping.
  
  
  METHODS
  IV.
authors.affiliation: HKF, International Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany. rainer.siebold@atos.de.|Institute for Anatomy and Cell Biology, INF, Karl-Ruprecht University Heidelberg, Heidelberg, Germany. rainer.siebold@atos.de.
authors.forename: Rainer
authors.initials: R
authors.lastname: Siebold
authors.affiliation: HKF, International Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany.|Sporthopaedicum Berlin, Berlin, Germany.
authors.forename: Ferzan
authors.initials: F
authors.lastname: Suezer
authors.affiliation: MRI-Department, German Cancer Research Center (DKFZ), INF, Heidelberg, Germany.|Siemens Healthcare Pty Ltd, Sydney, Australia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schmitt
authors.affiliation: Department of Radiology, MR Center-High Field MR, Medical University Vienna, Vienna, Austria.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Trattnig
authors.affiliation: MRI-Department, German Cancer Research Center (DKFZ), INF, Heidelberg, Germany.|Department of Radiology, University of Manitoba, Winnipeg, Canada.
authors.forename: Marco
authors.initials: M
authors.lastname: Essig
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000601:surgery*; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D048091:Guided Tissue Regeneration / Q000379:methods*; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACI; ACT3D; Autologous chondrocyte implantation; Cartilage defect; Knee; MOCART; Spheroid; T2 mapping