J. Gille (Hamburg, DE)

BGAOP Orthopaedic and Trauma Centre Trauma and Reconstructive Surgery
Prof. Dr. Justus Gille is an orthopaedic and trauma surgeon from Hamburg/Germany. He is member of multiple national and international societies e.g. the ICRS. Besides being a specialized surgeon he has been active in basic science and clinical trials in the field of cartilage repair for years. Examina 1999 - Medical Exam Thesis 2/2000 - University of Hamburg; Germany with Prof. Dr. med. Dr. h.c. mult. C. E. Broelsch; „Immunohistochemical detection of p53 expression in malignant liver tumors“ Habilitation treatise 5/2010 - University of Schleswig/Holstein with Prof. Dr. med. Ch. Juergens; “Matrix-Induced Chondrogenesis” Board approval 3/2006 - Approval in Orthopaedic and Trauma Surgery

Presenter Of 4 Presentations

Extended Abstract (for invited Faculty only) Cartilage and Meniscus

0.2 - Matrix-Induced Autologous Cartilage Repair (MACR) – An Update

Presentation Topic
Cartilage and Meniscus
Date
12.04.2022
Lecture Time
10:15 - 10:30
Room
Potsdam 3
Session Type
Plenary Session
Disclosure
Gille J: Grant Research Support, Geistlich Biomaterials

Abstract

Introduction

Articular cartilage lesions are a common pathology of the knee joint even in young patients resulting in pain and function loss. ith time). Given the limitations of MFx, efforts have focused on modifications and augmentation techniques for improving the quality of the repair tissue. Autologous, matrix-induced chondrogenesis (AMIC) is an enhanced MFx technique by covering the microfractured lesion site with a collagen I/III membrane in the knee (ChondroGide®, Geistlich Pharma AG).

Content

In basic science, Kramer et al. showed in an in-vitro work that a membrane consisting of collagen can retain cartilage building cells, like, e.g., mesenchymal stem cells from bone marrow after microfracturing [1]. Dickhut et al. [2] demonstrated in another in-vitro study that a biphasic carrier made of collagen type I/III supports chondrogenesis of MSCs and further that in comparison to collagen-free-membrane the form stability of the repair tissue was enhanced.

In vivo, 1 long-term study in sheep showed that AMIC significantly enhanced the cartilaginous repair tissue volume (eg, defect fill) compared with microfracture alone [3].

Intial clincal studies that have investigated short-term and medium-term follow-up cohorts suggest that AMIC in cartilage repair is a safe and effective treatment option that improves patient outcome measures and pain [4, 5]. To assess extended effectiveness and reliability of the AMIC procedure as well as the durability of the repaired cartilage, long-term follow up is essential. Two studies provide longer term data following an AMIC procedure, in which significant clinical and functional improvement was maintained over the 7-year follow-up [6, 7]. The AMIC procedure can be either performed with an open surgical approach or arthroscopically [8].

Steinwachs et al. summarize the results of 12 studies including 375 patients in a recent meta-analysis. The authors conclude that the AMIC procedure significantly improved the clinical status and functional scoring versus preoperative values [9].

References

[1] Kramer J, Böhrnsen F, Lindner U, Behrens P, Schlenke P, Rohwedel J. In vivo matrix-guided human mesenchymal stem cells. Cell Mol Life Sci 2006; 63: 616-626 [PMID: 16482398 DOI: 10.1007/s00018-005-5527-z]

[2] Dickhut A, Gottwald E, Steck E, Heisel C, Richter W. Chondrogenesis of mesenchymal stem cells in gel-like biomaterials in vitro and in vivo. Front Biosci 2008; 13: 4517-4528 [PMID: 18508526 DOI: 10.2741/3020]

[3] Gille J, Kunow J, Boisch L, Behrens P, Bos I, Hoffmann C, Köller W, Russlies M, Kurz B. Cell-Laden and Cell-Free Matrix-Induced Chondrogenesis versus Microfracture for the Treatment of Articular Cartilage Defects: A Histological and Biomechanical Study in Sheep. Cartilage 2010; 1: 29-42 [DOI: 10.1177/1947603509358721]

[4] Gille J, Behrens P, Volpi P, et al. Outcome of Autologous Matrix Induced Chondrogenesis (AMIC) in cartilage knee surgery: data of the AMIC Registry. Arch Orthop Trauma Surg. 2013;133(1):87-93.

[5] Gille J, Schuseil E, Wimmer J, et al. Mid-term results of Autologous Matrix-Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc. 2010;18(11):1456-1464.

[6] Schiavone Panni A, Del Regno C, Mazzitelli G, et al. Good clinical results with autologous matrix-induced chondrogenesis (AMIC) technique in large knee chondral defects. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2018;26(4):1130-1136.

[7] Gille J, Reiss E, Freitag M et al. AMIC for treatment of focal cartilage defects in the knee. Orthopaedic Journal of Sports Medicine. 2021; 66, 9(2) 2325967120981872

[8] Schagemann J, Behrens P, Paech A, et al. Mid-term outcome of arthroscopic AMIC for the treatment of articular cartilage defects in the knee joint is equivalent to mini-open procedures. Arch Orthop Trauma Surg. 2018;138(6):819-825.

[9] Steinwachs MR, Gille J, Volz M, et al. Systematic Review and Meta-Analysis of the Clinical Evidence on the Use of Autologous Matrix-Induced Chondrogenesis in the Knee. Cartilage. 2019:1947603519870846.

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Podium Presentation Clinical Outcome

18.2.2 - AMIC Provides Positive Outcomes in the Treatment of Retropatellar Chondral Lesions

Presentation Topic
Clinical Outcome
Date
14.04.2022
Lecture Time
14:24 - 14:33
Room
Potsdam 3
Session Name
Session Type
Free Papers
Disclosure
Gille J: Geistlich Pharma, Grant Reserach Support, DePuy Mitek, Paid Instructor

Abstract

Purpose

The patellofemoral joint can be a particularly challenging environment for treating chondral defects, due to the high loads acting on its surface. Among the different available surgical options for treatment of chondral defects, the single-stage AMIC procedure was performed, which uses a collagen I/III membrane to enhance bone-marrow stimulation. In order to ascertain the effectiveness of AMIC in treating chondral lesions, an ongoing registry has been established in order to record patient data and outcomes. Here, we evaluated the effectiveness of AMIC for patellar chondral lesions.

Methods and Materials

All data were retrieved from a multisite, prospective registry that recorded demographic data and outcomes for patients who had undergone surgical repair of patellar, chondral defects. In total, 63 patients from 5 surgeons were included in the analysis. All defects had been classified as Outerbridge III or IV and were treated with the 1-stage AMIC procedure.

Results

The mean lesion size was 3.2 ± 1.6 cm2. The most common surgical approach was mini-open while the most common fixation was via fibrin glue. Follow-up visits were conducted as part of the standard of care at each site. The figure below shows a significant improvement in the Lysholm

follow-up up to 10 years. Likewise, a significant decrease in pain VAS was noted at all post-operative timepoints (p<0.01). With regard to physical activity, the sports-recreation score showed a significant improvement, and at the latest follow-up was still significantly higher than the pre-operative score (P<0.05).

Conclusion

The data from this study demonstrate that the 1-stage AMIC procedure is an effective treatment for retropatellar cartilage defects, and provides positive results, as demonstrated by decreased pain and improved function of the patients. Importantly, these improvements were maintained up to 10 years after surgery.

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Podium Presentation Biomaterials and Scaffolds

18.2.7 - Autologous Matrix Induced Chondrogenesis (AMIC) for Treatment of Focal Cartilage Defects in the Knee: An Up to 7 Years Follow up Study.

Presentation Topic
Biomaterials and Scaffolds
Date
14.04.2022
Lecture Time
15:09 - 15:18
Room
Potsdam 3
Session Name
Session Type
Free Papers
Disclosure
J. Gille, Geistlich Biomaterials, Grant Research Support

Abstract

Purpose

Autologous Matrix Induced Chondrogenesis (AMIC) is a well-established treatment for full-thickness cartilage defects. The purpose of this study was to evaluate the long term clinical outcomes following repair, via AMIC procedure, of chondral defects of the knee.

Methods and Materials

A multi-site prospective registry recorded demographic data and outcomes for patients treated for repair of chondral defects. In total 131 patients were included in the study. Lysholm, KOOS and VAS-pain were used for outcome analysis. The average age of patients was 36.6±11.7 years. The mean body weight was 80.0±16.8 kg, with a mean height 176.3 ± 7.9 cm, and the mean defect size 3.3±1.8 cm2. Defects were classified as grade III / IV according to ICRS classification. A repeated measures ANOVA was used to compare outcomes across all time points.

Results

The median follow-up time for the patients in this cohort was 4.56 ± 2.92 years. Significant improvement (p<0.001) of all scores was observed at 1-2 years after AMIC and improved values were notable up to 7 years postoperatively. The mean preoperative Lysholm score was 46.9 (± 19.7). At the 1-2 year follow-up, a significant increase of Lysholm score mean values was noted (83.1 ± 14.0) with maintenance of the favorable outcome during follow up at 7 years: (78.6 ± 17.1). Similarly, The KOOS score also showed a significant improvement of the postoperative values compared to the preoperative data. The mean preoperative VAS was 5.7 ± 1.8 and this had significantly decreased to. 2.5 ± 2.1 at the 7 years follow up. Age, gender and defect size did not have a significant effect on the outcomes.

Conclusion

AMIC is an effective method of treating chondral defects of the knee and leads to reliably favorable results up to 7 years post-operatively.

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Poster Biomechanics

P249 - Gait Analysis After Cartilage Repair in the Knee Reveals no Significant Functional Alteration.

Presentation Topic
Biomechanics
Date
13.04.2022
Lecture Time
09:30 - 09:30
Room
Exhibition Foyer
Session Name
7.3 - Poster Viewing / Coffee Break / Exhibition
Session Type
Poster Session
Disclosure
J. Gille, Geistlich Biomaterials, Grant Research Support

Abstract

Purpose

Autologous Matrix Induced Chondrogenesis (AMIC) is a procedure with a substantial body of literature that demonstrates its performance in chondral and osteochondral repair. However, data concerning gait patterns and dynamic postural stability after cartilage repair procedures is lacking. Therefore, the present study was designed to assess gait pattern and postural stability following cartilage repair in the knee.

Methods and Materials

20 adults had undergone Autologous Matrix Induced Chondrogenesis for the treatment of full-thickness cartilage defects, with minimum 36 months of follow-up. Clinical outcomes were evaluated by patient reported outcome measures while dynamic postural stability, using the star excursion balance test, and gait parameters were evaluated via 3D kinematic analysis. The untreated, contralateral limbs served as controls.

Results

At a mean follow-up of 43 months, patients reported a Visual Analog Score for pain of 1.6±2.2, a mean Lysholm score of 78.5±17.9 and a mean Knee Osteoarthritis Outcome Score of 143.3±16.1. In gait, the only difference between was the knee angle at initial contact, which was significantly lower in the operated limb (18.3o±7.9 o) compared to the contralateral side (21.4 o±8.0 o). The star excursion balance test showed no significant difference between limbs. There were no significant correlations between joint kinematics, dynamic postural stability and patient reported outcome measures.

Conclusion

With minimal difference in gait and no difference in dynamic postural stability, our results indicate that this treatment provides a positive clinical outcome, normal joint kinematics and no deficits in postural stability.

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