Isık Akgun1, Mehmet C Unlu2, Ozan A Erdal3, Tahir Ogut3, Murat Erturk4, Ercument Ovali5, Fatih Kantarci6, Gurkan Caliskan7, Yamac Akgun8. 1. Department of Orthopaedics and Traumatology, Cactus Healthcare, Istanbul, Turkey. 2. Department of Orthopedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul University, 34303, Kocamustafapasa, Istanbul, Turkey. unludilek@hotmail.com. 3. Department of Orthopedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul University, 34303, Kocamustafapasa, Istanbul, Turkey. 4. Department of Medical Microbiology, Karadeniz Technical University, Trabzon, Turkey. 5. Labcell, Istanbul, Turkey. 6. Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. 7. Department of Orthopedics and Traumatology, Kanuni Sultan Suleyman State Hospital, Istanbul, Turkey. 8. Genetics and Molecular Biologist, Cellular Biologist, Trinity School of Medicine, Atlanta, USA.
Abstract
BACKGROUND: Cell-based strategies that combine in vitro- expanded autologous chondrocytes with matrix scaffolds are currently preferred for full-thickness cartilage lesions of the knee ≥2 cm(2). Although this approach is reasonable, continuing advances in the field of cartilage repair will further expand the options available to improve outcomes. HYPOTHESIS/ PURPOSE: In the present clinical study, we compared the outcomes of matrix-induced autologous mesenchymal stem cell implantation (m-AMI) with matrix-induced autologous chondrocyte implantation (m-ACI) for the treatment of isolated chondral defects of the knee. STUDY DESIGN: Prospective, single-site, randomized, single-blind pilot study. METHODS:Fourteen patients with isolated full-thickness chondral lesions of the knee >2 cm(2) were randomized into two treatment groups: m-AMI and m-ACI. Outcomes were assessed pre-operatively and 3, 6, 12 and 24 months post-operatively. RESULTS: Clinical evaluations revealed that improvement from pre-operation to 24 months post-operation occurred in both groups (p < 0.05). At all follow-up intervals, m-AMI demonstrated significantly better functional outcomes (motion deficit and straight leg raise strength) than did m-ACI (p < 0.05). At all follow-up intervals, m-AMI demonstrated significantly better subjective sub-scale scores for pain, symptoms, activities of daily living and sport and recreation of the knee injury and osteoarthritis outcome score (KOOS) than did m-ACI (p < 0.05). Additionally, m-AMI demonstrated significantly better (p < 0.05) scores than m-ACI for the quality of life sub-scale of the KOOS and visual analog scale (VAS) severity at the 6-month follow-up. The Tegner activity score and VAS frequency were not significantly different between the two groups. Graft failure was not observed on magnetic resonance imaging at the 24-month follow-up. m-AMI and m-ACI demonstrated very good-to-excellent and good-to-very good infill, respectively, with no adverse effects from the implant, regardless of the treatment. CONCLUSION: For the treatment of isolated full-thickness chondral lesion of the knee, m-AMI can be used effectively and may potentially accelerate recovery. A larger patient cohort and follow-up supported by histological analyses are necessary to determine long-term outcomes.
RCT Entities:
BACKGROUND: Cell-based strategies that combine in vitro- expanded autologous chondrocytes with matrix scaffolds are currently preferred for full-thickness cartilage lesions of the knee ≥2 cm(2). Although this approach is reasonable, continuing advances in the field of cartilage repair will further expand the options available to improve outcomes. HYPOTHESIS/ PURPOSE: In the present clinical study, we compared the outcomes of matrix-induced autologous mesenchymal stem cell implantation (m-AMI) with matrix-induced autologous chondrocyte implantation (m-ACI) for the treatment of isolated chondral defects of the knee. STUDY DESIGN: Prospective, single-site, randomized, single-blind pilot study. METHODS: Fourteen patients with isolated full-thickness chondral lesions of the knee >2 cm(2) were randomized into two treatment groups: m-AMI and m-ACI. Outcomes were assessed pre-operatively and 3, 6, 12 and 24 months post-operatively. RESULTS: Clinical evaluations revealed that improvement from pre-operation to 24 months post-operation occurred in both groups (p < 0.05). At all follow-up intervals, m-AMI demonstrated significantly better functional outcomes (motion deficit and straight leg raise strength) than did m-ACI (p < 0.05). At all follow-up intervals, m-AMI demonstrated significantly better subjective sub-scale scores for pain, symptoms, activities of daily living and sport and recreation of the knee injury and osteoarthritis outcome score (KOOS) than did m-ACI (p < 0.05). Additionally, m-AMI demonstrated significantly better (p < 0.05) scores than m-ACI for the quality of life sub-scale of the KOOS and visual analog scale (VAS) severity at the 6-month follow-up. The Tegner activity score and VAS frequency were not significantly different between the two groups. Graft failure was not observed on magnetic resonance imaging at the 24-month follow-up. m-AMI and m-ACI demonstrated very good-to-excellent and good-to-very good infill, respectively, with no adverse effects from the implant, regardless of the treatment. CONCLUSION: For the treatment of isolated full-thickness chondral lesion of the knee, m-AMI can be used effectively and may potentially accelerate recovery. A larger patient cohort and follow-up supported by histological analyses are necessary to determine long-term outcomes.
Authors: Upasana Kachroo; Abel Livingston; Elizabeth Vinod; Solomon Sathishkumar; P R J V C Boopalan Journal: Cartilage Date: 2018-08-23 Impact factor: 4.634
Authors: Joshua S Everhart; Moneer M Abouljoud; Sarah G Poland; David C Flanigan Journal: Knee Surg Sports Traumatol Arthrosc Date: 2018-10-15 Impact factor: 4.342
Authors: Hai Nie; Eva Kubrova; Tao Wu; Janet M Denbeigh; Christine Hunt; Allan B Dietz; Jay Smith; Wenchun Qu; Andre J van Wijnen Journal: PM R Date: 2019-05-30 Impact factor: 2.298
Authors: Bryan Michael Saltzman; Michael L Redondo; Adam Beer; Eric J Cotter; Rachel M Frank; Adam B Yanke; Brian J Cole Journal: Cartilage Date: 2018-10-31 Impact factor: 4.634