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Matrix-assisted chondrocyte transplantation with bone grafting for knee osteochondritis dissecans: stable results at 12 years

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To document clinical and radiological results of arthroscopic matrix-assisted autologous chondrocyte transplantation (MACT) combined with bone grafting for the treatment of knee osteochondritis dissecans (OCD) at long-term follow-up.

Methods

Thirty-one knees in 29 patients (20.4 ± 5.7 years) were treated for symptomatic unfixable OCD lesions (2.6 ± 1.1 cm2) and prospectively evaluated at 2, 5, and 12 years (average, minimum 10 years). Patients were evaluated over time with IKDC subjective score, EQ-VAS, and Tegner scores. Failures were also documented. At the final follow-up, MRI evaluation was performed in 14 knees with the MOCART 2.0 score.

Results

Beside 4 early failures, an overall clinical improvement was documented: the IKDC subjective score improved from 39.9 ± 16.8 to 82.1 ± 17.0 and 84.8 ± 17.2 at 2 and 5 years, respectively (p < 0.0005), and remained stable for up to 12 years (85.0 ± 20.2). EQ-VAS and Tegner scores presented similar trends, but patients did not reach their original activity level. Worse results were obtained for lesions bigger than 4 cm2. At MRI evaluation, subchondral bone abnormalities were detected in over 85% of knees at long-term follow-up.

Conclusions

Arthroscopic bone grafting followed by MACT for unfixable knee OCD can offer a promising and stable clinical outcome over time in lesions smaller than 4 cm2, with a low failure rate of 13%. Persistent subchondral alterations were documented at long-term MRI evaluation, suggesting the limits of this approach to regenerate the osteochondral unit in patients affected by knee OCD.

Level of evidence

IV.

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Funding

This research received no external funding.

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Authors and Affiliations

  1. Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy

    Luca Andriolo, Alessandro Di Martino, Sante Alessandro Altamura, Angelo Boffa, Alberto Poggi & Stefano Zaffagnini

  2. Centro di Riferimento di Radiologia in Attività di Ricerca, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Maurizio Busacca

  3. Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Giuseppe Filardo

  4. Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland

    Giuseppe Filardo

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  1. Luca Andriolo
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  2. Alessandro Di Martino
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  4. Angelo Boffa
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  7. Stefano Zaffagnini
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Correspondence to Angelo Boffa.

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Conflict of interest

Stefano Zaffagnini has received institutional support from Fidia Farmaceutici, Cartiheal, IGEA Clinical Biophysics, Biomet, and Kensey Nash; grant support from I+; and royalties from Springer. The other authors declare no conflict of interest.

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The Hospital Ethics Committee and Internal Review Board of the Rizzoli Orthopaedic Institute, Bologna, Italy (prot. gen. n. 39667) approved this study.

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Andriolo, L., Di Martino, A., Altamura, S.A. et al. Matrix-assisted chondrocyte transplantation with bone grafting for knee osteochondritis dissecans: stable results at 12 years. Knee Surg Sports Traumatol Arthrosc 29, 1830–1840 (2021). https://doi.org/10.1007/s00167-020-06230-y

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  • DOI: https://doi.org/10.1007/s00167-020-06230-y

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