Autologous chondrocyte transplantation has become a possible solution for the treatment of chondral knee lesions. Recently an autologous tissue engineered cartilage (Hyalograft C), using biodegradable scaffolds for cell proliferation, was successfully developed. In osteochondritis dissecans (OCD) the lesion also involves subchondral bone. For this reason we began to use a two-step technique: arthroscopic autologous bone grafting followed by autologouos condrocyte Hyalograft C transplantation after 4–6 months. We treated five patients affected by OCD. All the patients were clinically evaluated and analysed according to the International Repair Cartilage Society score at 12 and 24 months. The ICRS score showed highly satisfactory clinical results in all treated patients at 12 and 24 months; CT and MRI evaluation had demonstrated a good articular surface reconstruction with complete bone defect restoration at a short 12-month follow-up period. The autologous chondrocyte transplantation provides highly satisfactory clinical results. This second-generation autologous tissue-engineered cartilage transplantation avoids the use of periosteal flap, simplifies the surgical procedure and permits use of an arthroscopic approach. In association with autologous bone grafting, bone loss can also be restored in order to recreate a perfect articular surface. The preliminary clinical and histological results are encouraging but longer follow-up is required to better evaluate this technique.
Autologous chondrocyte transplantation has become a possible solution for the treatment of chondral knee lesions. In the last years matrix autologous chondrocyte transplantation procedures were developed by various scientists. We selected a biodegradable, hyaluronian-based biocompatible scaffold for cell proliferation. This nonwoven three-dimensional structure consists of a network of 20 – B5-thick fibers with interstices of variable sizes which constitute an optimal physical support to allow cell-cell contacts, cluster formation, and extracellular matrix deposition in order to create a bioengenerized cartilage Hyalograft C. The easy handling of Hyalograft C in open surgery has suggested us to investigate its possible use by an arthroscopic procedure. Arthroscopic technique has been used from December 2000 in 88 cases. At December 2003 45 patients achieved at least 1 year follow up and 22 patients – 2 years follow up. All the patients were clinically evaluated was analyzed according to the International Repair Cartilage Society score at 12 and 24 months. Returning back to sport was also recorded. We were able to obtain CT scans or MRI images for all patients at 6, 12 and 24 months of follow up. No complications related to the implant and no serious adverse events were observed during the treatment and follow up period. The IKDC objective score improved after 12 months in all patients, showing a normal or nearly normal knee in 96,7% of patients. The mean IKDC subjective score obtained was 41,3 at baseline, 76.9 at the 12 months follow-up control, and 75,9 after 24 months. The worsening of IKDC score was noted in 1 of 22 patients analyzed at 12 and 24 months follow up. A second look arthroscopy was performed in 11 patients at 12 months follow up and a complete healing of the defect and the excellent quality of regenerated cartilage was noted at macroscopic examination. The histological evaluation in 6 cases has demonstrated the hyaline type of new cartilage, although not completely mature. This matrix autologous chondrocyte transplantation procedure avoids the use of periosteal flap, simplify the surgical procedure and permit to perform the arthroscopic implant. Thus, complications as hypertrophy or ossification of periosteal flap are avoided and the surgical morbidity and the recovery time for the patient are extremely reduced. The preliminary clinical and histological results are encouraging but the decree absolute on the efficiency of this method will be assessed at longer follow up.
