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Arthroscopic gel-type autologous chondrocyte implantation presents histologic evidence of regenerating hyaline-like cartilage in the knee with articular cartilage defect

Authors
 Tae-Hwan Yoon  ;  Min Jung  ;  Chong-Hyuk Choi  ;  Hyoung-Sik Kim  ;  Young-Han Lee  ;  Yun-Seok Choi  ;  Sung-Jae Kim  ;  Sung-Hwan Kim 
Citation
 KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol.28(3) : 941-951, 2020 
Journal Title
 KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 
ISSN
 0942-2056 
Issue Date
2020
Keywords
Autologous chondrocyte implantation ; Cartilage ; Gel type ; Knee ; Minimally invasive
Abstract
PURPOSE: To investigate the clinical, radiological, and histological results of arthroscopic gel-type autologous chondrocyte implantation (GACI) in treating chondral defects of the knee. METHODS: This study prospectively examined five males and five females with a mean age of 40.3 ± 10.3 years who underwent arthroscopic GACI between March 2012 and February 2013. The gel comprised a mixture of 1 ml of fibrinogen plus 0.1-0.2 ml of thrombin. The mean size of chondral defect was 2.9 ± 1.2 cm2 (range 1.2-5.4 cm2). International knee documentation committee (IKDC) subjective score, knee injury and osteoarthritis outcome score (KOOS), knee society score, and visual analog scale (VAS) for pain were assessed preoperatively and during regular follow-up examinations performed for up to 5 years postoperatively. Serial magnetic resonance imaging was performed for up to 2 years after the surgery to observe healing, using the modified magnetic resonance observation of cartilage repair tissue (MOCART) score. In eight patients, second-look arthroscopy was performed at 1 year after the implantation to assess the status of treated cartilage, and a portion of regenerated cartilage was harvested for histologic evaluation. RESULTS: The mean VAS score (p = 0.045), IKDC subjective score (p = 0.041), KOOS pain (p = 0.025), KOOS activities of daily living (p = 0.048), and KOOS quality of life (p = 0.029) showed significant improvement at 5 years after the surgery. The modified MOCART evaluation showed that the scores were 59.5 ± 29.4 and 85.0 ± 8.0 at 12 weeks and 2 years after the operation, respectively. Histologic examination demonstrated a mean regenerated cartilage thickness of 3.5 ± 0.8 mm and a mean Oswestry score of 8.2 ± 1.8. Immunohistochemistry analysis showed that the expression of collagen type II was more evident and more evenly distributed than collagen type I in regenerated cartilage. There was a significant correlation between Oswestry score and change in VAS scale from postoperative 2-5 years. CONCLUSIONS: Arthroscopic GACI produces satisfactory clinical and radiologic outcomes, and histologic evaluation confirms sufficient regeneration of hyaline-like cartilage that correlates with improved symptoms. Therefore, it is an acceptable, minimally invasive, and technically simple option for the restoration of cartilage defects of the knee. LEVEL OF EVIDENCE: IV.
Full Text
https://link.springer.com/article/10.1007/s00167-019-05572-6
DOI
10.1007/s00167-019-05572-6
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sung Jae(김성재)
Kim, Sung Hwan(김성환) ORCID logo https://orcid.org/0000-0001-5743-6241
Kim, Hyoung Sik(김형식) ORCID logo https://orcid.org/0000-0002-9303-4116
Yoon, Tae Hwan(윤태환) ORCID logo https://orcid.org/0000-0002-2859-5240
Lee, Young Han(이영한) ORCID logo https://orcid.org/0000-0002-5602-391X
Jung, Min(정민) ORCID logo https://orcid.org/0000-0002-7527-4802
Choi, Yun Seok(최윤석)
Choi, Chong Hyuk(최종혁) ORCID logo https://orcid.org/0000-0002-9080-4904
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175532
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