Displaying One Session

Potsdam 1 Plenary Session
Session Type
Plenary Session
Date
12.04.2022
Time
13:15 - 14:15
Room
Potsdam 1
Session Description
Worldwide experts present the current therapeutic regimens and the future options to achieve effective cartilage repair
CME Evaluation
Extended Abstract (for invited Faculty only) Others

2.0.1 - Repair is not Good Enough?

Presentation Topic
Others
Date
12.04.2022
Lecture Time
13:15 - 13:30
Room
Potsdam 1
Session Type
Plenary Session

Abstract

Introduction

Hyaline cartilage is a very specialised tissue; it´s main constituents are proteoglycans that attract and retain water and highly organized type II collagen fibers oriented in an arcade like structures. Due to this composition and confirmation, it can transmit mechanical forces and act as a shock absorber1. In addition, hyaline cartilage has a zonal orientation with the lamina splendens being the uppermost layer. The lamina splendens provides the smooth layer for the smooth movement of articular joints, it is very rich in lubricin and collagen fibers run parallel to the surface of articulation2. So, articular cartilage can function due to its composition and their confirmation. This leads to the question whether repairing a cartilage defect is good enough3.

Content

Most of the currently used treatment procedures for cartilage defects do not provide a repair tissue that is similar to the native articular cartilage, or they come with other disadvantages.

For instance for microfracture it is well known that the repair tissue is more fibrocartilage-like that is rich in type I collagen instead of hyaline cartilage-like4. Although it provides satisfying outcomes on the short-term, the fibrocartilage cannot take over the function of hyaline cartilage and is more prone to degeneration on the long-term. Therefore, microfracture is only suitable for small defects and in larger defects the initial satisfactory outcomes can decline after a few years5. For larger (osteo)chondral defects autologous chondrocyte implantation or osteochondral allografts (if available) or other new upcoming treatments might provide a suitable treatment6-9. However, also these treatments do not provide 100% success. In addition, the question whether repair is good enough or not is also hampered by the lack of correlation between structural repair (MRI and / or histology) and patient reported outcome measures10. So even for a set of patients the tissue is repaired with a tissue that is similar to healthy cartilage, but there are still knee problems. On the other hand cartilage damage can be a surprise finding on imaging or during arthroscopy and be asymptomatic11.

References

1. Sophia Fox AJ, Bedi A, Rodeo SA. The basic science of articular cartilage: Structure, composition, and function. Sports Health. 2009;1(6):461–8.

2. Kumar P, Oka M, Toguchida J, Kobayashi M, Uchida E, Nakamura T, Tanaka K: Role of uppermost superficial surface layer of articular cartilage in the lubrication mechanism of joints. J Anat. 2001;199: 241-250.

3. Hunziker EB. The elusive path to cartilage regeneration. Adv Mater. 2009;21:3419–3424.

4. Steadman JR, Briggs KK, Rodrigo JJ, et al. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 2003;19:477-84.

5. Mithoefer K, McAdams T, Williams RJ, et al. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med. 2009;37:2053–2063.

6. Saris DBF, Vanlauwe J, Victor J, Almqvist KF, Verdonk R, Bellemans J. Treatment of Symptomatic Cartilage Defects of the Knee Characterized Chondrocyte Implantation Results in Better Clinical Outcome at 36 Months in a Randomized Trial Compared to Microfracture. Am J Sport Med. 2009;37:10–9.

7. Brittberg M, Recker D, Ilgenfritz J, Saris DBF. Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture: Five-Year Follow-up of a Prospective Randomized Trial. Am J Sports Med. 2018;46(6):1343–51.

8. Vonk LA, Roël G, Hernigou J, Kaps C, Hernigou P. Role of Matrix-Associated Autologous Chondrocyte Implantation with Spheroids in the Treatment of Large Chondral Defects in the Knee : A Systematic Review. Int J Mol Sci. 2021;22:7149.

9. Chahla J, Sweet MC, Okoroha KR, et al. Osteochondral Allograft Transplantation in the Patellofemoral Joint: A Systematic Review. Am J Sports Med. 2019;47(12):3009-3018.

10. De Windt TS, Welsch GH, Brittberg M, Vonk LA, Marlovits S, Trattnig S, et al. Is magnetic resonance imaging reliable in predicting clinical outcome after articular cartilage repair of the knee?: A systematic review and meta-analysis. Am J Sports Med. 2013;41:1695–702.

11. Horga LM, Hirschmann AC, Henckel J, et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol. 2020;49(9):1099-1107.

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Extended Abstract (for invited Faculty only) Cartilage /Cell Transplantation

2.0.2 - Restore Joints - A Complex Task?

Presentation Topic
Cartilage /Cell Transplantation
Date
12.04.2022
Lecture Time
13:30 - 13:45
Room
Potsdam 1
Session Type
Plenary Session

Abstract

Introduction

The success of cartilage repair techniques in the knee joint is multifaceted. A fundamental element to successful clinical outcomes is addressing the causation of the articular cartilage breakdown. Abnormal anatomy and altered biomechanical loading are common factors causing or contributing to cartilage loss in the knee. Such co-pathologies or “background factors” include tibiofemoral malalignment or meniscal deficiency, which exposes a joint compartment to excessive overloading. Altered patellofemoral alignment and kinematics are additional pathological features attributed to cartilage loss. When all causative factors are addressed, even the most advanced cases are amenable to biological repair with good to excellent clinical outcomes.

Content

The success of cartilage repair techniques in the knee joint is multifaceted. A fundamental element to successful clinical outcomes is addressing the causation of the articular cartilage breakdown. Abnormal anatomy and altered biomechanical loading are common factors causing or contributing to cartilage loss in the knee. Such co-pathologies or “background factors” include tibiofemoral malalignment or meniscal deficiency, which exposes a joint compartment to excessive overloading. Altered patellofemoral alignment and kinematics are additional pathological features attributed to cartilage loss. When all causative factors are addressed, even the most advanced cases are amenable to biological repair with good to excellent clinical outcomes.

For example, bipolar or “kissing” lesions in the patellofemoral compartment, a notoriously difficult problem for orthopedic surgeons, can be successfully treated with autologous chondrocyte implantation (ACI) and a concomitant osteotomy, when warranted. A case series of 58 patients (60 knees) who underwent ACI for repair of bipolar patellofemoral lesions demonstrated significant improvement in pain and function, with good survival rates at 5 and 10 years postoperatively (83% and 79%, respectively). Of this cohort, 42 (72%) patients had a corrective osteotomy for either patellofemoral lateral maltracking, patellar instability, or tibiofemoral malalignment. The best survivorship rates were observed among the patients who underwent ACI with a concurrent tibial tubercle osteotomy (TTO). Additional unpublished subcohort analysis demonstrated a 10-year survival rate of 91% when a TTO was performed at the time of ACI using a type I/III bilayer collagen membrane.

Likewise, we showed that ACI for the treatment of symptomatic bipolar cartilage lesions in the tibiofemoral compartments provides successful clinical outcomes in patients at mid- to long-term follow-up. Predisposing risk factors were addressed through concurrent osteotomies in 44 (76%) of the 58 knees. In this series, the survival rate was 80% at 5 years and 76% at 10 years, with significantly higher survival rates in the cohort of patients treated with collagen membrane versus periosteum (97% vs 61% at 5 years, respectively; p = .0014). The patient satisfaction was also high. Of the 46 knees with retained grafts, 91% were satisfied with their outcome, 85% rated their knee as better with the surgery, and 83% rated their outcome as good or excellent at a mean 8.3 years follow-up. At the final follow-up, 24 of the 46 successful knees were radiographically assessed and showed no significant osteoarthritis progression in K-L grading.

Another challenging problem for orthopedic surgeons that can be managed with consideration of the predisposing factors are cartilage lesions in the presence of meniscal deficiency. Our study evaluating 17 symptomatic patients (18 knees) with concomitant cartilage lesions and meniscal deficiency demonstrated 5- and 10-year survival rates of 75% with patient-reported functional improvements at a mean 7.9 years postoperative when meniscal allograft transplantation (MAT) was performed at the time of ACI. Of the cohort, there was no significant osteoarthritic progression using K-L grading from preoperative to mean 5.9 years postoperative. Thirteen patients (76%) maintained their native knee at the final follow-up.

All in all, challenging cases, ranging from bipolar cartilage lesions of the patellofemoral and tibiofemoral joints to cartilage lesions with concurrent meniscal deficiency, can be successfully treated through a means of joint preservation. Careful consideration and management of the causative factors, however, is imperative for good clinical outcomes.

References

Ogura T, Bryant T, Minas T. Biological Knee Reconstruction With Concomitant Autologous Chondrocyte Implantation and Meniscal Allograft Transplantation: Mid- to Long-term Outcomes. Orthop J Sports Med. 2016;4(10):2325967116668490. Published 2016 Oct 19. doi:10.1177/2325967116668490.

Ogura T, Bryant T, Merkely G, Minas T. Autologous Chondrocyte Implantation for Bipolar Chondral Lesions in the Patellofemoral Compartment: Clinical Outcomes at a Mean 9 Years' Follow-up. Am J Sports Med. 2019;47(4):837-846. doi:10.1177/0363546518824600.

Ogura T, Bryant T, Mosier BA, Minas T. Autologous Chondrocyte Implantation for Bipolar Chondral Lesions in the Tibiofemoral Compartment. Am J Sports Med. 2018;46(6):1371-1381. doi:10.1177/0363546518756977.

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Extended Abstract (for invited Faculty only) Please select your topic

2.0.3 - Regenerate - The Holy Grail?

Presentation Topic
Please select your topic
Date
12.04.2022
Lecture Time
13:45 - 14:00
Room
Potsdam 1
Session Type
Plenary Session
Extended Abstract (for invited Faculty only) Please select your topic

2.0.4 - Redefine the Goals of Cartilage Repair – What is Next?

Presentation Topic
Please select your topic
Date
12.04.2022
Lecture Time
14:00 - 14:15
Room
Potsdam 1
Session Type
Plenary Session