gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie
74. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie
96. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie
51. Tagung des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie

26. - 29.10.2010, Berlin

Safety study for a new technique of arthroscopic autologous chondrocyte transplantation using chondrospheres

Meeting Abstract

  • S. Rößing - Orthopädie am Alten Messplatz, Mannheim, Germany
  • T. Schreyer - Elisabethenstift Darmstadt, Klinik für Unfall-, Sport- und orthopädische Chirurgie, Darmstadt, Germany
  • P. Baum - Gelenkklinik Gundelfingen, Germany
  • H. Thermann - ATOS Praxisklinik Heidelberg, Germany
  • H. Pässler - ATOS Praxisklinik Heidelberg, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie. 74. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 96. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 51. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 26.-29.10.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocIN19-609

DOI: 10.3205/10dkou115, URN: urn:nbn:de:0183-10dkou1155

Veröffentlicht: 21. Oktober 2010

© 2010 Rößing et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The aim of the study was to proove the safety of the full arthroscopic approach in autologous chondrocyte transplantation (ACT) for full thickness cartilage defects of the medial/lateral and retropatellar compartement.

Methods: prospective cohort study; Level of evidence 3. multi center study (4 centers), clinical follow up 2 years . Mean follow-up was 2±0.1 years. 42 patients (mean age 38,3 years, range 18 to 50 yrs) underwent full arthroscopical autologous chondrocyte implantation with spheroids (ACT3D Codon Ag Teltow) of full size defects in the knee (medial/lateral condyle, retropatellar/trochlear compartement) with a mean defect size of 4,7 cm2 (range 2,5 to 9.5 cm2). Knee function was measured by Lysholm- and HSS score, Tegener activity scale, VAS. All patients underwent an one year follow up MRI. Statistical analysis in SPSS.

Results and conclusions: The study showed no increased risk or severe adverse events in the arthroscopical application. The two year follow up showed significant increased results in the Lysholm, HSS and tegner activity scoring. No revision surgery was needed during follow up time. Significant decrease of the VAS Pain assessment in the course of treatment. We implanted in the mean 38,5 spheroids/cm2 (range 10 to 292). This is corresponding to 7,7 million cells/cm2 (range 2 to 23,3 millions cells/cm2). The threshold dose of classical ACT of 1 million cells/cm2 (5/spheroids/cm2) was not under runned. The intraoperative loss of spheroids was estimated by the surgeons underneath 10% (5 Spheroids). Magnetic resonance imaging revealed that in the majority of cases, filling of the defect was accomplished with a non homogeneous surface and structure of the graft.

42 consecutive patients were treated in grade III to IV (Outerbridge/ICRS) cartilage defects with intact corresponding cartilage surface. The full arthroscopic application of autologous chondrocyte implantation using chondrospheres is a safe procedure that yields to significant functional improvement in the 2 years follow up time. An arthrotomy causing prolonged rehabilitation and significant more postoperative pain by damage of the soft tissue can be avoided. During operation no conversion to open procedure was necessary.

The risk of intraoperative spheroid loss can be controlled by an experienced arthroscopic surgeon. Even retropatellar defects can be reached without everting the patella. However, further investigations are necessary to determine the long-term structural and bio mechanical properties of the repair tissue. As well as controlled data in comparison to matrix based grafts are needed.

(Figure 1 [Fig. 1])