I. Guillen Vicente (Madrid, ES)
Clinica CEMTRO OrthopedicsPresenter Of 2 Presentations
12.1.1 - Cartilage Defect Treatment Using High-Density Autologous Chondrocyte Implantation
Abstract
Purpose
Autologous chondrocyte implantation (ACI) is a worldwide recognized therapy to treat focal cartilage lesions. Here we describe the experiments followed by our group to develop a modification of MACI called High Density-Autologous Chondrocyte Implantation (HD-ACI) in which cell density is increased 5-fold.
Methods and Materials
In classical ACI, 5 million of cultured chondrocytes were implanted in the cartilage defect, but the use of periosteum increased morbidity. In MACI, 20 million cells are seeded in a 20 cm2 collagen membrane, so cartilage defects are treated with a density of 1 million cells per cm2. Surgeons observed that neo-formed tissue was softer than normal cartilage and had scarce cell number. We proposed to increase cell density to 5 million cells per cm2, and first of all we had to prove its safety and effectiveness in a sheep model. In these experiments, 1 million and 5 million chondrocytes as well as 5 million mesenchymal stem cells were tested in 1 cm2 defects performed in the cartilage of the medial femoral condyle. In all animals, we carried-out other cartilage defects that were repaired with microfractures.
Results
Histological and molecular studies demonstrated that the animals treated with 5 million chondrocytes regenerated cartilage defects with a better hyaline cartilage than those treated with 1 million cells while fibrocartilage was produced in the animals treated with mesenchymal stem cells and in the defects treated with microfractures. Currently, 336 patients (251 in the knee, 82 in the ankle and 3 in the hip) have been treated with HD-ACI and in this work, we present the results of 176 treated in the knee and 48 in the ankle
Conclusion
Our results demonstrate that HD-ACI is a safe and effective technique for the treatment of cartilage defects, giving rise a neo-formed hyaline tissue and improving clinical and subjective perception of the joint functionality
P076 - Treatment of Bilateral Knee Chondral Defects with High-Density Autologous Chondrocyte Implantation (HD-ACI)
Abstract
Purpose
Bilateral knee chondral defects are uncommon and they can be treated in one or two surgical acts, each of one having pros and cons. In this work we have studied the clinical outcome of patients with bilateral knee chondral defects treated with High-Density Autologous Chondrocyte Implantation (HD-ACI) during the same surgery
Methods and Materials
Eight patients (4 women and 4 men) with chondral defects in both knees treated with HD-ACI during the same surgical act were included. Patients were evaluated 2, 6, 12 and 24 months post-op for treatment safety and efficacy. Safety was tested with the visual analogic scale (VAS) for pain, International Knee Documentation Committee (IKDC) for subjective patient’s perception of both knees and EuroQol five-dimensional five-level questionnaire (EQ-5D-5L) for quality of life. Integrity of neo-formed tissue at 12- and 24-month follow-up was assessed by the magnetic resonance observation of cartilage repair tissue (MOCART) score
Results
VAS decreased from baseline to 24 months from a median of 8 (6 – 9) to a median of 0 (0 – 5) (p<0.001). IKDC increased from a median value of 39.0 (17.2 – 48.3) in the basal visit to a median of 83.7 (24.0 – 98.0) in the 24-month visit (p<0.001). EQ-5D-5L decreased at 2 months post-op and increased throughout the follow-up visits thereafter, needing 24 months after surgery to reach a value higher than the basal one. Median MOCART at 12 months was 80.3 (58.0 – 89.7) and 81.3 (54.0 – 89.9) at 24 months
Conclusion
Treatment of both knees with HD-ACI during the same surgical act in patients with bilateral chondral lesions is a safe procedure, providing good clinical results
Presenter Of 1 Presentation
P076 - Treatment of Bilateral Knee Chondral Defects with High-Density Autologous Chondrocyte Implantation (HD-ACI)
Abstract
Purpose
Bilateral knee chondral defects are uncommon and they can be treated in one or two surgical acts, each of one having pros and cons. In this work we have studied the clinical outcome of patients with bilateral knee chondral defects treated with High-Density Autologous Chondrocyte Implantation (HD-ACI) during the same surgery
Methods and Materials
Eight patients (4 women and 4 men) with chondral defects in both knees treated with HD-ACI during the same surgical act were included. Patients were evaluated 2, 6, 12 and 24 months post-op for treatment safety and efficacy. Safety was tested with the visual analogic scale (VAS) for pain, International Knee Documentation Committee (IKDC) for subjective patient’s perception of both knees and EuroQol five-dimensional five-level questionnaire (EQ-5D-5L) for quality of life. Integrity of neo-formed tissue at 12- and 24-month follow-up was assessed by the magnetic resonance observation of cartilage repair tissue (MOCART) score
Results
VAS decreased from baseline to 24 months from a median of 8 (6 – 9) to a median of 0 (0 – 5) (p<0.001). IKDC increased from a median value of 39.0 (17.2 – 48.3) in the basal visit to a median of 83.7 (24.0 – 98.0) in the 24-month visit (p<0.001). EQ-5D-5L decreased at 2 months post-op and increased throughout the follow-up visits thereafter, needing 24 months after surgery to reach a value higher than the basal one. Median MOCART at 12 months was 80.3 (58.0 – 89.7) and 81.3 (54.0 – 89.9) at 24 months
Conclusion
Treatment of both knees with HD-ACI during the same surgical act in patients with bilateral chondral lesions is a safe procedure, providing good clinical results