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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

(A) Morphologic sagittal proton density-weighted image and (B) corresponding T2 map. Subchondral alterations are visible in the area of the repair site (white arrows). A homogeneous distribution of T2 values throughout is found, but values are lower at the repair site.
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fig2-1947603510381095: (A) Morphologic sagittal proton density-weighted image and (B) corresponding T2 map. Subchondral alterations are visible in the area of the repair site (white arrows). A homogeneous distribution of T2 values throughout is found, but values are lower at the repair site.

Mentions: The joint was opened through a medial or lateral mini-arthrotomy. Under moderate traction and plantar flexion, the defect was accessible from the anterior (Fig. 2). In 3 of 13 cases, medial malleolar osteotomy was necessary to achieve satisfactory access to the defect site. After debridement of the defect, the matrix was trimmed to fit the defect and implanted with fibrin glue fixation on the borders of the defect. The tourniquet was opened and the joint moved to verify graft stability.


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)

(A) Morphologic sagittal proton density-weighted image and (B) corresponding T2 map. Subchondral alterations are visible in the area of the repair site (white arrows). A homogeneous distribution of T2 values throughout is found, but values are lower at the repair site.
© Copyright Policy
Related In: Results  -  Collection

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

fig2-1947603510381095: (A) Morphologic sagittal proton density-weighted image and (B) corresponding T2 map. Subchondral alterations are visible in the area of the repair site (white arrows). A homogeneous distribution of T2 values throughout is found, but values are lower at the repair site.
Mentions: The joint was opened through a medial or lateral mini-arthrotomy. Under moderate traction and plantar flexion, the defect was accessible from the anterior (Fig. 2). In 3 of 13 cases, medial malleolar osteotomy was necessary to achieve satisfactory access to the defect site. After debridement of the defect, the matrix was trimmed to fit the defect and implanted with fibrin glue fixation on the borders of the defect. The tourniquet was opened and the joint moved to verify graft stability.

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