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Improvement seen 2 to 5 years after arthroscopic ACI with seeded HA scaffold
Scaffold’s chondroprotective properties are promising — next generation is in development.
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Italian investigators are reporting success with a second-generation autologous chondrocyte implantation technique up to 5 years postop.
The team has also conducted animal studies into a third-generation autologous chondrocyte implantation (ACI) technique involving a nonstructured biomimetic scaffold.
The second-generation approach involves arthroscopically implanting a three-dimensional (3-D) hyaluronan-based scaffold in the knee to repair damaged articular cartilage. Prior to implanting, the scaffold is seeded with autologous chondrocytes.
The new ACI technique could resolve implant morbidity and poor tissue quality seen with its first-generation counterpart, according to Stefano Zaffagnini, MD.
Some 5-year follow-up
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The new approach has produced promising clinical results due to the scaffold’s properties, Zaffagnini said. “[It] controls the delivery of hyaluronic acid (HA) to the site of the application, and it also has a structural role that allows cellular attachment and 3-D distribution of [the] chondrocytes.”
During the American Orthopaedic Society for Sports Medicine Specialty Day Meeting, Zaffagnini presented the results of 140 cases from a multicenter Italian study for indication, including traumatic femoral condyle lesions and osteochondritis dissecans.
Zaffagnini and colleagues prospectively followed 47 patients for 4 years and 21 patients for 5 years postop. In the group with 4-year follow-up, “We have seen significant improvement,” he said.
Despite the group’s small size, 93% of patients improved based on their mean subjective International Knee Documentation Committee (IKDC) scores.
Evaluations performed
Patients with 5-year follow-up improved from their 2-year postop subjective IKDC scores. Histological and MRI evaluations of the cartilage repairs supported these clinical results. MRI studies by Marlovits et al of the implants at 2 years postop yielded a statistically significant correlation between the clinical outcomes and radiological variables observed in the repair tissue. Hollander et al performed biopsies that revealed defects filled with a hyaline-like tissue in 50% of patients at 16 months postop.
For more information:
- Stefano Zaffagnini, MD, can be reached at Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy 40136; +39-051-6366502; e-mail: s.zaffagnini@biomec.ior.it. His study received material support from FAB, Padova, Italy.
- Hollander A, Dickinson SC, Sims TJ, et al. Maturation of tissue-engineered cartilage implanted in injured and osteoarthritic knees. Tissue Engineering. 2006;7:1787-1798.
- Marlovits S, Singer P, Zeller P, et al. Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: Determination of interobserver variability and correlation to clinical outcome after 2 years. Eur J Radiol. 2006;57(1):16-23.
- Zaffagnini S, Kon E, Delcogliano M, et al. Hyaluronan-based autologous chondrocyte implantation. Presented at the American Orthopaedic Society for Sports Medicine Specialty Day Meeting. Feb. 17, 2007. San Diego.