Friday, February 15, 2002
Using a collagen membrane instead of a periosteum flap for matrix-associated autologous chondrocyte transplantation (MACT) may be a more effective treatment for articular cartilage lesions, according to poster exhibit 485.
Between 1998 and 2001, 40 patients underwent MACT to repair localized cartilage defects in the knee (38 patients) and ankle (2 patients); 25 patients (all knee) were available for follow-up of two years. Patient ages ranged from 19 to 58 years (mean patient age = 35 years). All patients had undergone previous surgeries, including debridement, abrasion and drilling, with no improvement. The aaverage defect size was 5.6 cm². Twelve defects were located on the medial femoral condyle, six on the patella, one on the lateral femoral condyle and six in more than one site.
The MACT technique involved in vitro construction of a cell matrix biocomposit. Autologous chondrocytes were seeded on a type-I/III-collagen membrane (Chondrogide®, Geistlich, Wolhusen, Switzerland). The culturing process of the chondrocytes and the quality control was performed at Verigen Transplantation Services International, Copenhagen, Denmark. This biocomposit was then fixed by partial autologous fibrin glue (Tissucol®, Baxter-Immuno, Heidelberg, Germany) and autologous serum from the patients to the cartilage defect in a mini-open operative procedure.
The clinical assessment of patients used standard rating scales and magnetic resonance images. At a mean follow-up of 24 months, 23 patients showed improvement in their Meyers scores, from 12.1 to 17.9 (p < 0.05). Lysholm/Gillquist scores improved for all patients, from 63.2 to 85.9 (p < 0.05). MRI scanning results after one year could not detect the quality of cartilage defect repair, which is comparable to a good clinical outcome. Histology of two patients showed hyaline-like cartilage stained for collagen type-II. Twenty-three patients reported overall improvement and two patients remained unchanged.
Based on these results, researchers concluded that the MACT technique might be a promising alternative treatment for localized cartilage defects of the knee and ankle. There is no overgrowth with a standardized membrane, which could reduce the number of second-look operations. Further research is focusing on membranes for localized cartilage defect treatment, with or without cells. This can improve the so-called autologous matrix-induced condrogenesis (AMIC®). Using a standardized matrix can not only reduce the operation time and costs but also open the possibility for new arthroscopic techniques in cartilage repair treatments.
Researchers include Peter Behrens, MD, Justus Gille, MD, Sybille Offenhäuser, MD, and Martin Russlies, MD, all from the Department of Orthopaedics, University of Luebeck, Germany. The Verigen and Geistlich Company provided research or institutional support for the project.
|2002 Academy News February 15 Index B|
Last modified 08/February/2002