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Survival was 91% at 5 years with three generations of ACI to treat talar lesions
Results showed patients' mean ankle scores increased 19 points from baseline to final follow-up after autologous chondrocyte implantation.
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Three-fourths of patients who underwent one of the three generations of autologous chondrocyte implantation for osteochondral defects of the talus reported they were satisfied or extremely satisfied with their results at final follow-up, according to a presenter.
“Our study is the first to look at three generations of [autologous chondrocyte implantation] ACI. It is the largest series to date looking at up to 12-year follow-up. It showed significant functional improvement with ACI at medium term, especially with the first and third generation,” registrar Anup Pradhan, MRCS(Eng), BMedSc, MBChB(Hons), said in a presentation at the British Orthopaedic Association Annual Congress.
The review study Pradhan and colleagues conducted included 57 patients with a mean age of 35 years and a mean follow-up of 6 years (2 to 12 years) who underwent the ACI procedures between June 1998 and October 2012 at Robert Jones and Agnes Hunt Orthopaedic Hospital, in Oswestry, United Kingdom.
Mostly medial lesions
Two-thirds of the patients were men and two-thirds of the lesions were on the medial talar dome. One-third of patients underwent first generation ACI where cartilage chondrocytes from a non-weight bearing area of the ankle were biopsied and chondrocytes were cultured over 3 weeks in the OSCELL National Health System facility. Pradhan and colleagues acknowledge the hard work growing the chondrocytes done by Paul Harrison, Julie Davies and Helen Dean at the OSCELL lab in Oswestry.
The cultured chondrocytes were injected into a defect that was debrided and the treated defect was then covered with a periosteal membrane.
Pradhan noted nearly half of the patients underwent second generation ACI where the Chondro-Gide (Geistlich Pharma AG) matrix was used instead of the periosteum to cover the defect.
“[Matrix-induced ACI] MACI was done in 17% of patients; 76% of the patients had previous procedures prior to ACI, which was mainly debridement and the mean duration prior to ACI was nearly 3 years,” said Pradhan.
MACI involves seeding a synthetic matrix with cultured chondrocytes. The matrix is then placed over the debrided defect.
Patients highly satisfied
The mean size of the osteochondral defects treated was 199 mm2. At final follow-up, about 75% of patients were pleased or extremely pleased with their surgery.
“At 1-year postop, the third generation of MACI had highly significant scores compared to the other two groups and at final follow-up the first generation with the periosteum had a significantly better score than the second generation,” Pradhan said.
Pradhan said ACI survival was 91% at 5 years.
“We feel it is a good option for patients who have failed bone marrow stimulation procedures and we did not demonstrate a significant difference in survival between the three generations,” Pradhan said. – by Susan M. Rapp
- Reference:
- Pradhan A, et al. Paper #509. Presented at: British Orthopaedic Association Annual Congress. Sept. 13-16, 2016; Belfast, Northern Ireland.
- For more information:
- Anup Pradhan, MRCS(Eng), BMedSc, MBChB(Hons), can be reached at The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, SY10 7AG United Kingdom; email: anup.pradhan@rjah.nhs.uk.
Disclosure: Pradhan reports no relevant financial disclosures.
Perspective
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Martinus Richter, MD, PhD
Pradhan and colleagues investigated autologous chondrocyte implantation (ACI) and matrix-induced ACI or MACI at the ankle. ACI and MACI are two-stage procedures (stage one: harvesting of cartilage; stage two: implantation). Between the two stages, chondrocytes are cultivated in a laboratory. MACI was performed in nine ankles and ACI was performed on 51 ankles. The mean follow-up was 5.7 years and the principal outcome parameter was a satisfaction score.
Considering the actual literature, the follow-up time is good whereas the case number is low, especially for the MACI group. The outcome score is not validated. In the actual literature, single-stage procedures, such as autologous matrix-induced chondrogenesis and matrix-associated stem cell transplantation have been reported to have very good validated score results. This calls into question whether the more complex (two stages) and costly (chondrocyte cultivation) ACI and MACI procedures actually represent the optimal treatment of choice.
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