Karl-Friedrich Schüttler1, A Götschenberg2, A Klasan2, T Stein3,4, A Pehl5, P P Roessler6, J Figiel7, T J Heyse2, T Efe2,8. 1. Centre for Orthopedics and Trauma surgery, University Hospital Marburg, 35043, Marburg, Germany. kschuett@med.uni-marburg.de. 2. Centre for Orthopedics and Trauma surgery, University Hospital Marburg, 35043, Marburg, Germany. 3. Department of Sporttraumatology, Knee-and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany. 4. Department of Sports Science, University of Bielefeld, Bielefeld, Germany. 5. Department of Pathology, Philipps-University of Marburg, Marburg, Germany. 6. Department of Orthopedics and Traumatology, University Hospital Bonn, Bonn, Germany. 7. Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Marburg, Germany. 8. Orthopeadicum Lich, Gottlieb-Daimler-Str. 7a, 35423, Lich, Germany.
Abstract
INTRODUCTION: Cartilage defects of the knee remain a challenging problem in orthopedic surgery despite the ongoing improvements in regenerative procedures such as the autologous chondrocyte transplantation. Due to the lack of donor-site morbidity and the single-stage procedure cell-free scaffolds are an interesting alternative to cell-based procedures. But as currently mid- and long-term data are lacking, the aim of the present study was to present mid-term clinical, radiological and histological results of a cell-free collagen type I scaffolds for cartilage repair. MATERIALS AND METHODS: Twenty-eight patients were followed prospectively. Clinical evaluation using patient-reported outcome measures (KOOS, IKDC; VAS for pain, Tegner score for activity) as well as radiologic evaluation of the repair tissue (MOCART) was performed at 1 year, 2 years and 5 years. Histologic evaluation of the repair tissue was done in case of revision surgery using the ICRS II score for human cartilage repair. RESULTS: In these large cartilage defects with a mean defect size of 3.7 ± 1.9 cm2, clinical failure necessitating revision surgery was seen in 5 of 28 patients (18%). While the remaining patients showed good-to-excellent clinical results (KOOS, IKDC, VAS, Tegner), the radiologic appearance of the repair tissue showed a reduction of the MOCART score between the 2- and 5-year follow-up. Histologic evaluation of the repair tissue showed a cartilage-like appearance with no signs of inflammation or cell death but an overall medium tissue quality according to the ICRS II Score. CONCLUSION: The use of this cell-free collagen type I scaffold for large defects showed increased wear of the repair tissue and clinical failure in 18% of cases at 5-year follow-up.
INTRODUCTION:Cartilage defects of the knee remain a challenging problem in orthopedic surgery despite the ongoing improvements in regenerative procedures such as the autologous chondrocyte transplantation. Due to the lack of donor-site morbidity and the single-stage procedure cell-free scaffolds are an interesting alternative to cell-based procedures. But as currently mid- and long-term data are lacking, the aim of the present study was to present mid-term clinical, radiological and histological results of a cell-free collagen type I scaffolds for cartilage repair. MATERIALS AND METHODS: Twenty-eight patients were followed prospectively. Clinical evaluation using patient-reported outcome measures (KOOS, IKDC; VAS for pain, Tegner score for activity) as well as radiologic evaluation of the repair tissue (MOCART) was performed at 1 year, 2 years and 5 years. Histologic evaluation of the repair tissue was done in case of revision surgery using the ICRS II score for humancartilage repair. RESULTS: In these large cartilage defects with a mean defect size of 3.7 ± 1.9 cm2, clinical failure necessitating revision surgery was seen in 5 of 28 patients (18%). While the remaining patients showed good-to-excellent clinical results (KOOS, IKDC, VAS, Tegner), the radiologic appearance of the repair tissue showed a reduction of the MOCART score between the 2- and 5-year follow-up. Histologic evaluation of the repair tissue showed a cartilage-like appearance with no signs of inflammation or cell death but an overall medium tissue quality according to the ICRS II Score. CONCLUSION: The use of this cell-free collagen type I scaffold for large defects showed increased wear of the repair tissue and clinical failure in 18% of cases at 5-year follow-up.
Authors: Justus Gille; Ellen Reiss; Moritz Freitag; Jan Schagemann; Matthias Steinwachs; Tomasz Piontek; Eric Reiss Journal: Orthop J Sports Med Date: 2021-02-26
Authors: Arnd Hoburg; Philipp Niemeyer; Volker Laute; Wolfgang Zinser; Thilo John; Christoph Becher; Kaywan Izadpanah; Peter Diehl; Thomas Kolombe; Jakob Fay; Rainer Siebold; Stefan Fickert Journal: Orthop J Sports Med Date: 2022-01-18