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Autologous chondrocyte implantation to repair knee cartilage injury: ultrastructural evaluation at 2 years and long-term follow-up including muscle strength measurements

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Autologous chondrocyte implantation (ACI) usually results in improvement in clinical scores. However, long-term isokinetic muscle strength measurements have not been reported. Biopsies from the repair tissue have shown variable proportions of hyaline-like cartilage. In this study, 21 consecutive patients were treated with autologous cartilage implantations in the knee. Mean size of the lesions was 5.5 cm2. Follow-up arthroscopy with biopsy was performed at 2 years in 19 patients. The biopsies were examined with both light microscopy and transmission electron microscopy (TEM) techniques including immunogold analysis of collagen type 1. Patient function was evaluated with modified 10-point scales of the Cincinnati knee rating system obtained preoperatively and at 1 and 8.1 years. Isokinetic quadriceps and hamstrings muscle strength testing was performed at 1, 2 and 7.4 years. Light microscopy and TEM both showed predominately fibrous cartilage. The immunogold analysis showed a high percentage of collagen type I. At 7.4 years, the total work deficits when compared with the contra-lateral leg for isokinetic extension were 19.1 and 11.4%, and for isokinetic flexion 11.8 and 8.5% for 60 and 240º/s, respectively. Mean pain score improved from 4.3 preoperatively to 6.3 at 1 year (p = 0.031) and 6.6 at 8.1 years (p = 0.013). Overall health condition score improved from 4.1 preoperatively to 6.1 at 1 year (p = 0.004) and 6.5 at 8.1 years (p = 0.008). Three patients later went through revision surgery with other resurfacing techniques and are considered failures. In summary, the formation of fibrous cartilage following ACI was confirmed by TEM with immunogold histochemistry. Although the functional scores were generally good, strength measurements demonstrated that the surgically treated leg remained significantly weaker.

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Acknowledgments

The authors thank Ingar Holme, PhD, for statistical advice and Bioengineer Aileen Murdoch Larsen for technical assistance. The study was supported by grants from the Norwegian Foundation for Health and Rehabilitation and Oslo Sports Trauma Center. The Oslo Sports Trauma Research Center has been established at the Norwegian University of Sport & Physical Education through generous grants from the South-Eastern Norway Regional Health Authority, the Royal Norwegian Ministry of Education and Research, the Norwegian Olympic Committee & Confederation of Sport and Norsk Tipping AS. No affiliations or conflicting interests declared.

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Authors and Affiliations

  1. Orthopaedic Centre, Ullevål University Hospital and Medical School, Oslo, Norway

    Sverre Løken, Tom C. Ludvigsen & Lars Engebretsen

  2. Oslo Sports Trauma Research Center, Norwegian University of Sport and Physical Education, Oslo, Norway

    Sverre Løken & Lars Engebretsen

  3. Institute of Pathology and the Pathology Clinic, Rikshospitalet University Hospital, University of Oslo, Oslo, Norway

    Finn P. Reinholt

  4. Norwegian Sports Medicine Institute, Oslo, Norway

    Turid Høysveen

  5. Department of Rehabilitation, Rikshospitalet University Hospital, University of Oslo, Oslo, Norway

    Inger Holm

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  1. Sverre Løken
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Correspondence to Sverre Løken.

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Løken, S., Ludvigsen, T.C., Høysveen, T. et al. Autologous chondrocyte implantation to repair knee cartilage injury: ultrastructural evaluation at 2 years and long-term follow-up including muscle strength measurements. Knee Surg Sports Traumatol Arthrosc 17, 1278–1288 (2009). https://doi.org/10.1007/s00167-009-0854-5

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