To present our preliminary results in fully arthroscopically performed 3-dimensional autologous cartilage transplantation (ACT-3D) for medium to large focal chondral defects at the knee.

We treated operatively in our Dept., 35 symptomatic patients between March 2007 and May 2008. The mean age was 32 years old. The mean area of cartilage defect was 6.75cm² (2.2–10cm²) and all the cases were classified as grade III(16) and IV(18) according to Out-erbrigde scale. 18 of the cartilage lesions were located in the weight-bearing surface of the medial femoral condyle, 8 in the lateral one, 6 in the trochlea area and 2 in the lateral facet of the patella. We performed 15 applications of ACT3D as single procedure. Apart from that, we performed 11 ACL reconstructions combined with the 3D-spheres. Preop. and postoperative evaluation of patients was done using the Modified Cincinatti (MC) Rating System(0–100), the VAS (visual analogue pain score) (0–10), IKDC Knee examination score and Patient Outcome Function score.

All the cases were performed uneventfully. No major complications were seen. All cases followed a specialized rehabilitation protocol. In MC Rating System the result rose from 41.5 to 72.5 and in VAS, pain significantly reduced from 6.1 to 1.8 in 12 months time. The Patient Outcome Function score showed 81% better, 18% same and 1% worse results. The follow-up using MRI showed adequate filling of the defect without significant bone swelling.

Arthroscopically performed chondrocyte implantation (ACT) is an innovative technique with early results very promising. It’s surgeon demanding, although it’s fast performed technique and well tolerated operation. A greater number of cases and further mid and long term follow-up has to be studied in order to prove the efficacy of the method.

Purpose: To present our experience in using autologous 3D chondrocyte implantation, performed in fully arthroscopical manner, for treatment of cartilage defects, due to osteochondritis descecans in the talus.

Materials and Methods: A total of 12 patients were presented to our clinic with severe ankle pain due to osteochondritis descecans in the right(8) and left(4) talus between June 2008 and June 2009. The lesions were located at the medial aspect of the right talus (7) and the medial aspect of the left talus (4) as well as the central aspect (1) of the right talus, measuring (8) 1×1.5 cm2 and (4) 1.5x1.5 cm2 were classified intraoperatively as Outerbridge IV. They underwent arthroscopy in order to collect cartilage from non-weight bearing area of the talus(1st stage ACI) and then send it for chondrocyte culture. After 6 weeks the cultivated chondrocytes were applied fully arthroscopically as 3D chondrospheres to cover the chondral defects(2nd stage ACI). Pre-op and post-op evaluation was done using the LYSHOLM & GILLQUIST score, Patient Outcome Function score and Visual Analogue Pain score.

Results: The procedures progressed uneventfully. A specialized rehabilitation protocol was followed. We assessed the patient at six months and 1 year post-operatively; the Lysholm & Gillquist Score rose from 45.5 to 72.5, in VAS pain significantly reduced from 6.3 to 1.7 in the 1 year period and the Patient Outcome Function score showed significantly better performance. The follow-up using MRI showed adequate filling of the defect without significant graft-associated complications for the same period. The clinical outcome was excellent.

Conclusions: Our preliminary results of autologous 3D chondrocyte implantation for the treatment of cartilage defects, due to osteochondritis descecans in the talus seems to be more than encouraging. A greater number of cases and further mid and long term follow-up has to be studied in order to prove the efficacy of the method. As far as we know this is the first publication in the literature regarding 3nd generation ACI technique fully arthroscopically performed, concerning the talus, in our country.