Treatment of Deep Cartinalge Defects of the Knee with Autologous Chondrocyte Transplantation on a Hyaluronic Acid Ester Scaffolds (Hyalograft C)
Abstract
Purpose of the study: The treatment of chondral defects by transplantation of autologous chondrocytes has recently shown further development. Various biomaterials are used as carriers facilitating attachment and even distribution of chondrocytes in the defect.
Since 2003 Hyalograft C, hyaluronan-based scaffolds, has been used, in a clinical study, for implantation of autologous chondrocytes in the treatment of deep chondral lesions of the knee at our department. Material: Eight patients (7 men and 1 woman; average age, 31 years) followed up for at least 9 months were evaluated.
The lesions with an average size of 3.9 cm2 were localized on femoral condyles. Methods: The outcome of surgery was evaluated on the basis of the IKDC Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm knee score.
The patients underwent MR examination preoperatively and at 3, 6 and 12 months after surgery. The newly-formed cartilage was assessed by International Cartilage Repair Society (ICRS) visual scores at second-look arthroscopy carried out at 9 to 12 months following transplantation.
Consistency of the new cartilage developing in the defect and that of healthy cartilage around the defect was compared by means of a special indentation probe in three patients. A biopsy sample was collected from the grafted site for histological, histochemical and immunohistochemical examination.
Results: All patients reported improvement in knee function on average at 10 months after surgery. The average IKDC subjective score increased from 46 points preoperatively to 74 points postoperatively.
The KOOS evaluation showed pain relief and improved function. In quality of life evaluation the average score of 35 points before surgery increased to 70 points after it.
The average Lysholm knee score was 61 points before and 83 points after surgery. MR findings correlated well with arthroscopic findings.