Autologous Chondrocyte Implantation and Osteochondral Cylinder Transplantation in Cartilage Repair of the Knee Joint : A Prospective, Comparative Trial

• Published in: Journal of bone and joint surgery. American volume Vol. 85; no. 2; pp. 185 - 192
• Main Authors: Horas, U., Pelinkovic, D., Herr, G., Aigner, T., Schnettler, R.
• Format: Journal Article
• Language: English
• Published: Boston, MA Copyright by The Journal of Bone and Joint Surgery, Incorporated 01.02.2003; Journal of Bone and Joint Surgery Incorporated; Journal of Bone and Joint Surgery AMERICAN VOLUME
• Edition: American volume
• Subjects: Adolescent; Adult; Biological and medical sciences; Bone Transplantation - methods; Cartilage, Articular - transplantation; Cell Transplantation - methods; Chondrocytes - transplantation; Female; Humans; Joint Diseases - pathology; Joint Diseases - surgery; Knee Joint - pathology; Knee Joint - surgery; Male; Medical sciences; Orthopedic Procedures - rehabilitation; Orthopedic surgery; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Transplantation, Autologous; Treatment Outcome; Knee; Human; Prognosis; Chondrocyte; Substance loss; Diseases of the osteoarticular system; Lower limb; Histology; Knee disease; Cylinder; Autograft; Orthopedic surgery; Chondropathy; Treatment; Articular cartilage; Graft; Clinical trial; Technique
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200302000-00001

BackgroundCurrent methods used to restore the joint surface in patients with localized articular cartilage defects include transplantation of an autologous osteochondral cylinder and implantation of autologous chondrocytes. The purpose of this study was to evaluate the clinical and histological outcomes of these two techniques.MethodsWe performed a prospective clinical study to investigate the two-year outcomes in forty patients with an articular cartilage lesion of the femoral condyle who had been randomly treated with either transplantation of an autologous osteochondral cylinder or implantation of autologous chondrocytes. Biopsy specimens from representative patients of both groups were evaluated with histological staining, immunohistochemistry, and scanning electron microscopy.ResultsAccording to the postoperative Lysholm score, the recovery after autologous chondrocyte implantation was slower than that after osteochondral transplantation at six months (p ≤ 0.015), twelve months (p ≤ 0.001), and twenty-four months (p ≤ 0.012). On the basis of the Meyers score and the Tegner activity score, the results were equally good with the two methods two years after treatment. Histomorphological evaluation of biopsy specimens within two years after autologous chondrocyte implantation demonstrated a complete, mechanically stable resurfacing of the defect in all patients. The tissue consisted mainly of fibrocartilage, while localized areas of hyaline-like regenerative cartilage could be detected close to the subchondral bone. Although a gap remained at the site of the transplantation in all five biopsy specimens examined as long as two years after osteochondral cylinder transplantation, histomorphological analysis and scanning electron microscopy revealed no differences between the osteochondral transplants and the surrounding original cartilage.ConclusionsBoth treatments resulted in a decrease in symptoms. However, the improvement provided by the autologous chondrocyte implantation lagged behind that provided by the osteochondral cylinder transplantation. Histologically, the defects treated with autologous chondrocyte implantation were primarily filled with fibrocartilage, whereas the osteochondral cylinder transplants retained their hyaline character, although there was a persistent interface between the transplant and the surrounding original cartilage. Limitations of our study included the small number of patients, the relatively short (two-year) follow-up, and the absence of a control group.Level of EvidenceTherapeutic study, Level II-2 (poor-quality randomized controlled trial [e.g., <80% follow-up]). See Instructions to Authors for a complete description of levels of evidence.