Nothing Special   »   [go: up one dir, main page]
Skip to main content
Springer Nature Link
Log in

Use of cell-free collagen type I matrix implants for the treatment of small cartilage defects in the knee: clinical and magnetic resonance imaging evaluation

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy

Abstract

Purpose

Articular cartilage defects of the knee are a common condition for which several repair techniques have been described. The aim of the present study was to assess medium-term results of a one-step procedure using a cell-free collagen type I matrix.

Methods

Fifteen patients with articular cartilage defects of the knee were treated with an 11-mm-diameter cell-free collagen type 1 matrix implant. The matrices were implanted in a press-fit manner into the defect after careful debridement down to the subchondral bone but without penetration of this margin. Follow-up examinations were carried out at 6 weeks, 6 months, and at 12, 24, 36, and 48 months after implantation. Clinical assessment included the visual analogue scale (VAS), the Tegner activity scale, and the International Knee Documentation Committee (IKDC) score. Radiological assessment for graft attachment and tissue regeneration was performed using the magnetic observation of cartilage repair tissue (MOCART) score.

Results

A total of 15 patients (males: n = 6 and females: n = 9) with a mean age of 26.4 years (range 19–40) were treated. The mean VAS improved significantly when compared to the preoperative values (P < 0.05). Six weeks after implantation, IKDC values were slightly lower than the preoperative values (n.s.), but increased significantly at final follow-up (P < 0.05). At 24 months, there were no significant differences in the median Tegner score between the post-operative values and the preoperative values (n.s.). However, after 36 months, a significant improvement was noted that lasted at least up to 48 months (P < 0.05). The MOCART score improved consistently up to 4 years after implantation, with significant improvements already observed after 12 months (P < 0.05). No correlation between the clinical scores and the MOCART score could be perceived.

Conclusion

The present study showed that the use of cell-free collagen type I matrix implants led to a significant and durable improvement in all the clinical and imaging scores investigated 4 years after implantation.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bartlett W, Skinner JA, Gooding CR, Carrington RW, Flanagan AM, Briggs TW, Bentley G (2005) Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 87:640–645

    Article  CAS  PubMed  Google Scholar 

  2. Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg 85-A(Suppl 2):58–69

    PubMed  Google Scholar 

  3. Christensen BB, Foldager CB, Hansen OM, Kristiansen AA, Le DQ, Nielsen AD, Nygaard JV, Bunger CE, Lind M (2012) A novel nano-structured porous polycaprolactone scaffold improves hyaline cartilage repair in a rabbit model compared to a collagen type I/III scaffold: in vitro and in vivo studies. Knee Surg Sports Traumatol Arthrosc 20:1192–1204

    Article  PubMed  Google Scholar 

  4. Dhollander AA, Verdonk PC, Lambrecht S, Almqvist KF, Elewaut D, Verbruggen G, Verdonk R (2011) The combination of microfracture and a cell-free polymer-based implant immersed with autologous serum for cartilage defect coverage. Knee Surg Sports Traumatol Arthrosc 20:1773–1780

    Article  PubMed  Google Scholar 

  5. Efe T, Theisen C, Fuchs-Winkelmann S, Stein T, Getgood A, Rominger MB, Paletta JR, Schofer MD (2012) Cell-free collagen type I matrix for repair of cartilage defects-clinical and magnetic resonance imaging results. Knee Surg Sports Traumatol Arthrosc 20:1915–1922

    Article  PubMed  Google Scholar 

  6. Flandry F, Hunt JP, Terry GC, Hughston JC (1991) Analysis of subjective knee complaints using visual analog scales. Am J Sports Med 19:112–118

    Article  CAS  PubMed  Google Scholar 

  7. Gavenis K, Schneider U, Maus U, Mumme T, Muller-Rath R, Schmidt-Rohlfing B, Andereya S (2012) Cell-free repair of small cartilage defects in the Goettinger minipig: which defect size is possible? Knee Surg Sports Traumatol Arthrosc 20:2307–2314

    Article  CAS  PubMed  Google Scholar 

  8. Gobbi A, Nunag P, Malinowski K (2005) Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc 13:213–221

    Article  PubMed  Google Scholar 

  9. Guettler JH, Demetropoulos CK, Yang KH, Jurist KA (2004) Osteochondral defects in the human knee: influence of defect size on cartilage rim stress and load redistribution to surrounding cartilage. Am J Sports Med 32:1451–1458

    Article  PubMed  Google Scholar 

  10. Harris JD, Siston RA, Pan X, Flanigan DC (2010) Autologous chondrocyte implantation: a systematic review. J Bone Joint Surg Am 92:2220–2233

    PubMed  Google Scholar 

  11. Henderson I, Francisco R, Oakes B, Cameron J (2005) Autologous chondrocyte implantation for treatment of focal chondral defects of the knee—a clinical, arthroscopic, MRI and histologic evaluation at 2 years. Knee 12:209–216

    Article  PubMed  Google Scholar 

  12. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613

    CAS  PubMed  Google Scholar 

  13. James SL, Connell DA, Saifuddin A, Skinner JA, Briggs TW (2006) MR imaging of autologous chondrocyte implantation of the knee. Eur Radiol 16:1022–1030

    Article  CAS  PubMed  Google Scholar 

  14. Kalson NS, Gikas PD, Briggs TW (2010) Current strategies for knee cartilage repair. Int J Clin Pract 64:1444–1452

    Article  CAS  PubMed  Google Scholar 

  15. Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M, Sudkamp N (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil 14:1119–1125

    Article  CAS  PubMed  Google Scholar 

  16. LaPrade RF, Botker JC (2004) Donor-site morbidity after osteochondral autograft transfer procedures. Arthroscopy 20:69–73

    Article  Google Scholar 

  17. Marlovits S, Aldrian S, Wondrasch B, Zak L, Albrecht C, Welsch G, Trattnig S (2012) Clinical and radiological outcomes 5 years after matrix-induced autologous chondrocyte implantation in patients with symptomatic, traumatic chondral defects. Am J Sports Med 40:2273–2280

    Article  PubMed  Google Scholar 

  18. Marlovits S, Singer P, Zeller P, Mandl I, Haller J, Trattnig S (2006) Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: determination of interobserver variability and correlation to clinical outcome after 2 years. Eur J Radiol 57:16–23

    Article  PubMed  Google Scholar 

  19. Marquass B, Mahn T, Engel T, Gossner J, Theopold JD, von Dercks N, Racynski C, Rose T, Josten C, Hepp P (2012) Clinical and radiological mid-term results after autologous osteochondral transplantation under consideration of quality of life. Z Orthop Unfall 150:360–367

    CAS  PubMed  Google Scholar 

  20. Micheli LJ, Browne JE, Erggelet C, Fu F, Mandelbaum B, Moseley JB, Zurakowski D (2001) Autologous chondrocyte implantation of the knee: multicenter experience and minimum 3-year follow-up. Clin J Sport Med 11:223–228

    Article  CAS  PubMed  Google Scholar 

  21. Morales TI (2007) Chondrocyte moves: clever strategies? Osteoarthr Cartil 15:861–871

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Niemeyer P, Pestka JM, Kreuz PC, Erggelet C, Schmal H, Suedkamp NP, Steinwachs M (2008) Characteristic complications after autologous chondrocyte implantation for cartilage defects of the knee joint. Am J Sports Med 36:2091–2099

    Article  PubMed  Google Scholar 

  23. Schneider U, Rackwitz L, Andereya S, Siebenlist S, Fensky F, Reichert J, Loer I, Barthel T, Rudert M, Noth U (2011) A prospective multicenter study on the outcome of type I collagen hydrogel-based autologous chondrocyte implantation (CaReS) for the repair of articular cartilage defects in the knee. Am J Sports Med 39:2558–2565

    Article  PubMed  Google Scholar 

  24. Schneider U, Schmidt-Rohlfing B, Gavenis K, Maus U, Mueller-Rath R, Andereya S (2011) A comparative study of 3 different cartilage repair techniques. Knee Surg Sports Traumatol Arthrosc 19:2145–2152

    Article  PubMed  Google Scholar 

  25. Sohn DH, Lottman LM, Lum LY, Kim SG, Pedowitz RA, Coutts RD, Sah RL (2002) Effect of gravity on localization of chondrocytes implanted in cartilage defects. Clin Orthop Relat Res 394:254–262

    Article  PubMed  Google Scholar 

  26. Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484

    Article  PubMed  Google Scholar 

  27. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  28. Vijayan S, Bartlett W, Bentley G, Carrington RW, Skinner JA, Pollock RC, Alorjani M, Briggs TW (2012) Autologous chondrocyte implantation for osteochondral lesions in the knee using a bilayer collagen membrane and bone graft: a two- to eight-year follow-up study. J Bone Joint Surg Br 94:488–492

    Article  CAS  PubMed  Google Scholar 

  29. Welsch GH, Trattnig S, Domayer S, Marlovits S, White LM, Mamisch TC (2009) Multimodal approach in the use of clinical scoring, morphological MRI and biochemical T2-mapping and diffusion-weighted imaging in their ability to assess differences between cartilage repair tissue after microfracture therapy and matrix-associated autologous chondrocyte transplantation: a pilot study. Osteoarthr Cartil 17:1219–1227

    Article  CAS  PubMed  Google Scholar 

  30. Willers C, Chen J, Wood D, Xu J, Zheng MH (2005) Autologous chondrocyte implantation with collagen bioscaffold for the treatment of osteochondral defects in rabbits. Tissue Eng 11:1065–1076

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The magnetic resonance imaging was supported by a research fund of Arthro Kinetics.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany

    Karl F. Schüttler, Hanno Schenker, Christina Theisen, Markus D. Schofer, Philip P. Roessler, Johannes Struewer & Turgay Efe

  2. Department of Trauma, Hand and Reconstructive Surgery, Wilhelms University Münster, Münster, Germany

    Christina Theisen

  3. Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON, Canada

    Alan Getgood

  4. Department of Radiology, University Hospital Marburg, Marburg, Germany

    Marga B. Rominger

Authors
  1. Karl F. Schüttler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hanno Schenker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christina Theisen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Markus D. Schofer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alan Getgood
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philip P. Roessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Johannes Struewer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marga B. Rominger
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Turgay Efe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Turgay Efe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schüttler, K.F., Schenker, H., Theisen, C. et al. Use of cell-free collagen type I matrix implants for the treatment of small cartilage defects in the knee: clinical and magnetic resonance imaging evaluation. Knee Surg Sports Traumatol Arthrosc 22, 1270–1276 (2014). https://doi.org/10.1007/s00167-013-2747-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-013-2747-x

Keywords