AUTOLOGOUS CHONDROCYTE GRAFTS FOR THE TREATMENT OF KNEE CARTILAGE DAMAGE: OUTCOME AT MORE THAN FOUR YEARS

Abstract

Purpose: Use of autologous chondrocyte grafts for the treatment of knee cartilage damage appears to be a promising solution. We report preliminary retrospective results in 15 autologous chondrocyte grafts with maximum 4.1 years follow-up.

Material and methods: From September 1996 to December 2000, 15 autologous chondrocyte grafts were performed in 15 patients (13 men and two women), mean age 29.1 years (14.2–46.5) using the Carticel procedure of the Genzyme Tissue Repair laboratory. There were ten trauma-induced chondral lesions and five cases of osteochondritis dessicans. The lesions were located in the femoral condyles in 14 cases (12 medial and two lateral) and the patella in one. Mean surface defect was 6 cm2 (1–15) and all lesions were ICRS grade 3 or 4. The technique described by Brittberg et al. was used. Harvested cartilage was sent to Cam-bridge (USA) for culture. Reimplantation, performed by arthrotomy in all cases, was achieved 12 weeks on average (3.5–29) after initiating culture. Clinical and laboratory results at last follow-up were compared with preoperative data using the ICRS evaluation chart and the Tegner, IKDC, modified Cincinnati, and Lysholm scores. Patients were followed regularly with x-rays, MRI or arthroscan.

Results: Mean follow-up was 2.5 years (1.2–4.1). The subjective IKDC, modified Cincinnati, and Lysholm scores progressed respectively from 38.3 (9–46) to 71.3 (24–98), from 31.6 (18–69) to 58.4 (26–97) and from 41.9 (13–61) to 81.3 (29–100). According to this classification, outcome was excellent or good in ten knees, fair in four and poor in one. For the activity level assessed by the ICRS and Tegner classifications, scores declined respectively from 2.2 (1–3) and 7.4 (5–10) preoperatively to 2.8 (2–4) and 5.2 (2–7) at last follow-up.

Discussion: Due to the small number of patients, it is difficult to compare our results with those reported in the literature. Clinical and functional improvement appeared to be significant but in our experience, there was a decline in the mean sports level at last follow-up.

Conclusion: Autologous chondrocyte grafting appears to be a promising technique for repairing cartilage damage. Use of second-generation grafts with chondrocytes embedded in a solid matrix should facilitate their surgical implantation and improve outcome.