Delays in autologous chondrocyte implantation may lead to knee cartilage defect expansion
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Published results showed long delays between two-stage cell-based cartilage restoration surgeries with either autologous chondrocyte implantation or matrix autologous chondrocyte implantation may put patients at risk for defect expansion.
“Unlike other tissues, cartilage does not naturally regenerate. That is why cartilage injuries are chronic and frequently get worse as time goes on,” David C. Flanigan, MD, of The Ohio State University Wexner Medical Center, told Healio. “Time becomes increasingly important as it relates to patients undergoing cell-based knee cartilage restoration, and this study illustrates that cartilage damage can progress and new defects can form as time between cartilage biopsy and implantation increases.”
Flanigan and colleagues performed a retrospective chart review of data for 111 patients with full-thickness symptomatic knee cartilage defects without signs of tricompartmental arthritis who underwent either autologous chondrocyte implantation or third-generation matrix autologous chondrocyte implantation. Adjusting for demographics, BMI, smoking status, coronal alignment, initial cartilage status and prior surgery, researchers determined the relationship between time between biopsy and staged implantation with progression in primary cartilage defect size, as well as development of a new high-grade cartilage defect.
Researchers found the average size of the primary defect was 4.50 cm2 at time of biopsy, and the mean time to chondrocyte implantation was 155 days. Results showed an increase of defect expansion of 0.11 cm2 per-month delay to implantation. Researchers identified male sex, smaller initial defect size and delay to implantation as independent predictors of defect expansion. A new high-grade defect developed in 16.2% of patients, according to results. Researchers also noted Outerbridge grade 2 changes on the surface opposing the index defect and delayed implantation as independent predictors of a new secondary defect.
“The future of orthopedics relies on the success of innovative advancements, such as cell-based treatments. Backed by data from this study, surgeons and patients can make more informed decisions about treatment plans, specifically in regard to timing,” Flanigan said. “I hope that our findings can guide streamlined, successful treatment plans for patients in the process of undergoing cell-based knee cartilage restoration and mitigate risk of defects progressing and new high-grade defects forming.”
Perspective
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Leela C. Biant, MS, MFSTEd, FRCSEd(Tr&Orth)
The main finding of this study shows an increase in the size of a cartilage defect between surgeries with increased delays to second-stage autologous chondrocyte implantation/matrix autologous chondrocyte implantation. This is not surprising as large defects do further degenerate and expand with time. It is interesting to note the authors finding of a discrepancy between first- and second-stage surgery, even in those patients with a shorted interval between surgeries. However, it must be remembered that a thorough open debridement at second stage will certainly mean the defect measures larger than measured with a ruler arthroscopically at first stage. Expedited treatment should be an aim for all cartilage restoration procedures to prevent or delay further degenerative change.
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