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Matrix-associated stem cell transplantation seen as safe for MTP joint chondral defects
Patients had no complications and required no reoperations or fusions during the study period.
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TORONTO — Treatment of chondral defects of the first metatarsophalangeal joint with matrix-associated stem cell transplantation led to good clinical scores and improved range of motion in patients, according to study results presented at the American Orthopaedic Foot and Ankle Society Annual Meeting, here.
“Matrix-associated stem cell transplantation (MAST) is a single surgery in contrast to cartilage transplantation. MAST is safe and predicts a good outcome. Our data is difficult to compare with literature because there is no other study including pedography or validated scores out there. But, I am sure it [MAST] is better than cheilectomy alone,” Martinus Richter, MD, PhD, professor in the Department of Foot and Ankle Surgery Nuremberg and Rummelsberg at Hospital Rummelsberg in Schwarzenbruck, Germany, said.
Improvements with MAST
Richter and colleagues analyzed 20 patients (70% were men) with 25 chondral defects of the first metatarsophalangeal (MTP) joint treated with matrix-associated stem cell transplantation (MAST) from April 2009 to March 2013. Researchers registered and analyzed the size and location of the chondral defects, any method-associated problems, the VAS Foot and Ankle score and first MTP range of motion.
Researchers performed MAST as a single open procedure, which included debridement and microfracture of the chondral defects. Richter noted in his presentation that, during the procedure, surgeons harvested stem cell-rich blood from bone marrow obtained from ipsilateral pelvic bone and then centrifuged it. Using the supernatant from that process, researchers impregnated a collagen I/III matrix Chondro-Guide (Geislitch Pharma) that was cut to the size of the defect and then fixed the matrix with the stem cells into the chondral defect with Tissucoll, a fibrin glue (Baxter Healthcare Corp.).
Future research
Seven defects were located at the medial metatarsal head, and 18 defects were located at the lateral metatarsal head. These had an average size of 0.7 cm2. Before surgery, the average VAS Foot and Ankle score was 50.5 points, which improved to an average of 91.5 point following MAST treatment. Richter also noted improvement occurred in range of motion, as well as in the extent of hallux rigidus.
“We did not register any method-related complications,” Richter said. “None of the patients were reoperated until 2-year follow-up. None of the patients sustained a fusion.”
Richter and colleagues are working on a similar study of this technique with a longer follow-up and more patients, as well as a system using the matrix that is easier to use and less expensive.
“We are developing a system for the same method with all necessary items (matrix, syringe, Jamshidi needle, fibrin glue, centrifuge) in one system for easier and cheaper application,” Richter told Orthopaedics Today Europe. “Of course, we are continuing the use of real stem cells as described.” – by Casey Tingle
- Reference:
- Richter M, et al. Two-year follow-up in 20 patients after matrix-associated stem cell transplantation (MAST) in chondral defects of the first metatarsophalangeal joint. Presented at: American Orthopaedic Foot and Ankle Society Annual Meeting; July 20-23, 2016; Toronto.
- For more information:
- Martinus Richter, MD, PhD, can be reached at Department for Foot and Ankle Surgery Nuremberg and Rummelsberg, Hospital Rummelsberg, Rummelsberg 71, 90592 Schwarzenbruck, Germany; email: martinus.richter@sana.de.
Disclosure: Richter reports no relevant financial disclosures.