gms | German Medical Science

Joint German Congress of Orthopaedics and Trauma Surgery

02. - 06.10.2006, Berlin

Treatment of chondral defects of the knee with hyalograft C

Meeting Abstract

  • A. Podškubka - Orthopaedic Clinic Bulovka, Institute for Postgraduate Medical Educations, Prague, Germany
  • J. Vaculík - Orthopaedic Clinic Bulovka, Institute for Postgraduate Medical Educations, Prague, Czech Republic
  • C. Povýšil - Institute of Pathologic Anatomy, 1st Medical School Charles University, Prague, Germany
  • Z. Matejovský - Orthopaedic Clinic Bulovka, Institute for Postgraduate Medical Educations, Prague, Czech Republic
  • P. Cinegr - Orthopaedic Clinic Bulovka, Institute for Postgraduate Medical Educations, Prague, Czech Republic

Deutscher Kongress für Orthopädie und Unfallchirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 92. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie und 47. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 02.-06.10.2006. Düsseldorf, Köln: German Medical Science; 2006. DocW.4.5.2-736

The electronic version of this article is the complete one and can be found online at:

Published: September 28, 2006

© 2006 Podškubka et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Aim of the study: In the past few years we have seen further progress in the treatment of chondral defects by transplanting autologous chondrocytes. Different biomaterials are used as temporary carriers for fixation and an even distribution of chondrocytes in the defects. Since 2003 we have implemented a clinical trial for the treatment of deep chondral defects in the knee by transplanting autologous chondrocytes fixed in a scaffold from hyaluronic acid esters (Hyalograft C). This material has been evaluated in a prospective study.

Material: We evaluated results in 8 transplanted patients (7 males and 1 female, average age of 31 years) with a minimal follow up of 9 months after surgery. Defects of an average size of 3.9 cm2 were localized on femoral condyles.

Method: We evaluated the functional outcomes (IKDC, KOOS, Lysholm score) and performed MRI before and 3,6 and 12 months after surgery. The newly formed cartilage was controlled visually (ICRS visual score) during a control arthroscopy at 9 to 12 months after transplantation. We compared the stiffness of the repair tissue with the surrounding cartilage using a specially developed electromechanical indentation probe. Specimens for histological, histochemical and immunohistochemical studies were harvested from the site of transplanted chondrocytes.

Results: Improvement of the knee joint was confirmed in all patients at an average time of 10 months following surgery. The average IKDC subjective score improved from 46 points before surgery to 74 points after surgery. Using the KOOS scoring system, we observed a decrease in pain and improvement of function. When evaluating life quality, the average score improved from 35 points before surgery to 70 points at control. The preoperative Lysholm score was 61 points compared to 83 points postoperatively. We found a good correlation of MRI and arthroscopic findings. During control arthroscopy, the newly formed cartilage was evaluated as nearly normal in 6 and as abnormal in 2 cases. The average ICRS visual score was 9.4 points. No graft failure was detected. The newly-formed tissue had a histological picture of a mixed cartilage in 7 patients and a hyaline cartilage in 1 patient.

Conclusion: Functional improvement of the knee could be followed in all patients. Hyalograft C leads to formation of new cartilage at the defect site. Well-fixed tissue of a mainly mixed (fibrohyaline) type formed in less than a year. The scaffold carrier is resorbed without problems. A one-year period seems too short for complete remodeling of a newly formed immature cartilage tissue into a hyaline cartilage.