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Matrix-Associated and Autologous Chondrocyte Transplantation in the Ankle: Clinical and MRI Follow-up after 2 to 11 Years.

Nehrer S, Domayer SE, Hirschfeld C, Stelzeneder D, Trattnig S, Dorotka R - Cartilage (2011)

Bottom Line: Significant improvement was found in all cases.MRI data demonstrated good defect filling, and T2 mapping results indicated that the collagen and water content of the repair tissue was comparable to adjacent cartilage.MACT and ACT in the ankle can provide good and excellent long-term outcome and resulted in repair tissue with T2 properties similar to native cartilage in the majority of cases.

View Article: PubMed Central - PubMed

Affiliation: Centre of Regenerative Medicine, Danube University of Krems, Austria.

ABSTRACT

Background: New matrix-associated autologous chondrocyte transplantation (MACT) techniques may facilitate the treatment of chondral defects in talar cartilage and provide good clinical outcome in the long term. The aim of this prospective case series was to monitor the clinical outcome after autologous chondrocyte transplantation (ACT) and MACT in the ankle to gain data on the mid-term efficacy of the procedure.

Methods: Seventeen cases of talar cartilage defects were assessed with the American Orthopaedic Foot and Ankle Score (AOFAS), a modified Cincinnati score, and a subjective ankle-hindfoot score (AHS) at a mean of 61 (24-135) months after surgery. Nine patients consented to an additional magnetic resonance imaging (MRI) exam, including T2 mapping at 3T. ACT was carried out with a periosteal flap (4 cases) or with a matrix-assisted ACT technique (Hyalograft C; 13 cases).

Results: Significant improvement was found in all cases. The AOFAS improved from 50.0 to 87.3, the AHS from 43.8 to 84.1, and the modified Cincinnati score from 2.9 to 6.9. MRI data demonstrated good defect filling, and T2 mapping results indicated that the collagen and water content of the repair tissue was comparable to adjacent cartilage.

Discussion: MACT and ACT in the ankle can provide good and excellent long-term outcome and resulted in repair tissue with T2 properties similar to native cartilage in the majority of cases. Matrix-assisted implantation with the hyaluronan matrix allows for a less invasive surgical procedure.

Level of evidence: 4; prospective case series study.

No MeSH data available.


Related in: MedlinePlus

Surgical procedure of autologous chondrocyte transplantation with a periosteal flap: osteochondral defect with a (A) delaminated piece of cartilage, (B) debrided defect, and (C) malleotomy and suturing of the periosteal flap.
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fig1-1947603510381095: Surgical procedure of autologous chondrocyte transplantation with a periosteal flap: osteochondral defect with a (A) delaminated piece of cartilage, (B) debrided defect, and (C) malleotomy and suturing of the periosteal flap.

Mentions: Depending on the defect location, a medial or lateral miniarthrotomy was performed and the defect debrided to achieve a clean osseous ground of the defect with perpendicular borders. The periosteal flap was harvested from the adjacent distal tibia and sutured to the adjacent cartilaginous border with 6-0 Vicryl sutures to create a waterproof compartment in the defect. Finally, the chondrocyte suspension was injected into the defect site underneath the periosteal patch and closed with the last suture (Fig. 1). It may be worth noting that osteotomy was inevitable in two cases because of the suturing of the graft rather than because of the accessibility of the defect sites.


Matrix-Associated and Autologous Chondrocyte Transplantation in the Ankle: Clinical and MRI Follow-up after 2 to 11 Years.

Nehrer S, Domayer SE, Hirschfeld C, Stelzeneder D, Trattnig S, Dorotka R - Cartilage (2011)

Surgical procedure of autologous chondrocyte transplantation with a periosteal flap: osteochondral defect with a (A) delaminated piece of cartilage, (B) debrided defect, and (C) malleotomy and suturing of the periosteal flap.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4300785&req=5

fig1-1947603510381095: Surgical procedure of autologous chondrocyte transplantation with a periosteal flap: osteochondral defect with a (A) delaminated piece of cartilage, (B) debrided defect, and (C) malleotomy and suturing of the periosteal flap.
Mentions: Depending on the defect location, a medial or lateral miniarthrotomy was performed and the defect debrided to achieve a clean osseous ground of the defect with perpendicular borders. The periosteal flap was harvested from the adjacent distal tibia and sutured to the adjacent cartilaginous border with 6-0 Vicryl sutures to create a waterproof compartment in the defect. Finally, the chondrocyte suspension was injected into the defect site underneath the periosteal patch and closed with the last suture (Fig. 1). It may be worth noting that osteotomy was inevitable in two cases because of the suturing of the graft rather than because of the accessibility of the defect sites.

Bottom Line: Significant improvement was found in all cases.MRI data demonstrated good defect filling, and T2 mapping results indicated that the collagen and water content of the repair tissue was comparable to adjacent cartilage.MACT and ACT in the ankle can provide good and excellent long-term outcome and resulted in repair tissue with T2 properties similar to native cartilage in the majority of cases.

View Article: PubMed Central - PubMed

Affiliation: Centre of Regenerative Medicine, Danube University of Krems, Austria.

ABSTRACT

Background: New matrix-associated autologous chondrocyte transplantation (MACT) techniques may facilitate the treatment of chondral defects in talar cartilage and provide good clinical outcome in the long term. The aim of this prospective case series was to monitor the clinical outcome after autologous chondrocyte transplantation (ACT) and MACT in the ankle to gain data on the mid-term efficacy of the procedure.

Methods: Seventeen cases of talar cartilage defects were assessed with the American Orthopaedic Foot and Ankle Score (AOFAS), a modified Cincinnati score, and a subjective ankle-hindfoot score (AHS) at a mean of 61 (24-135) months after surgery. Nine patients consented to an additional magnetic resonance imaging (MRI) exam, including T2 mapping at 3T. ACT was carried out with a periosteal flap (4 cases) or with a matrix-assisted ACT technique (Hyalograft C; 13 cases).

Results: Significant improvement was found in all cases. The AOFAS improved from 50.0 to 87.3, the AHS from 43.8 to 84.1, and the modified Cincinnati score from 2.9 to 6.9. MRI data demonstrated good defect filling, and T2 mapping results indicated that the collagen and water content of the repair tissue was comparable to adjacent cartilage.

Discussion: MACT and ACT in the ankle can provide good and excellent long-term outcome and resulted in repair tissue with T2 properties similar to native cartilage in the majority of cases. Matrix-assisted implantation with the hyaluronan matrix allows for a less invasive surgical procedure.

Level of evidence: 4; prospective case series study.

No MeSH data available.


Related in: MedlinePlus