Good healing potential of patellar chondral defects after all-arthroscopic autologous chondrocyte implantation with spheroids: a second-look arthroscopic assessment

Yoshikazu Sumida; Kaori Nakamura; Sven Feil; Maja Siebold; Joachim Kirsch; Rainer Siebold

doi:10.1007/s00167-021-06584-x

Good healing potential of patellar chondral defects after all-arthroscopic autologous chondrocyte implantation with spheroids: a second-look arthroscopic assessment

Knee Surg Sports Traumatol Arthrosc. 2022 May;30(5):1535-1542. doi: 10.1007/s00167-021-06584-x. Epub 2021 Apr 23.

Authors

Yoshikazu Sumida^{1

2}, Kaori Nakamura¹, Sven Feil¹, Maja Siebold¹, Joachim Kirsch³, Rainer Siebold^{4

5}

Affiliations

¹ International Center for Orthopedics, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany.
² Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
³ Institute for Anatomy and Cell Biology, Ruprecht-Karls University, INF 307, 69120, Heidelberg, Germany.
⁴ International Center for Orthopedics, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany. rainer.siebold@atos.de.
⁵ Institute for Anatomy and Cell Biology, Ruprecht-Karls University, INF 307, 69120, Heidelberg, Germany. rainer.siebold@atos.de.

PMID: 33891163
DOI: 10.1007/s00167-021-06584-x

Abstract

Purpose: To report second-look arthroscopic assessment after all-arthroscopic autologous chondrocyte implantation (ACI) for articular cartilage defects at the patella.

Methods: A second-look arthroscopy after all-arthroscopic ACI using chondrospheres^® (ACT3D) was performed in 30 patients with 30 full-thickness retropatellar cartilage defects. The mean time from ACI to second-look arthroscopy was 14.9 ± 16.3 (6-71) months. The quality of cartilage regeneration was evaluated by the International Cartilage-Repair Score (ICRS)-Cartilage Repair Assessment (CRA).

Results: Eleven lesions (36.7%) were classified as CRA grade I (normal) and 19 lesions (63.3%) as grade II (nearly normal). Concerning the degree of defect repair, 25 lesions (83.3%) were repaired up to the height of the surrounding articular retropatellar cartilage. Five lesions (16.7%) showed 75% repair of defect depth. The border zone was completely integrated into the surrounding articular cartilage shoulder in 28 lesions (93.3%) and demarcated within 1 mm in 2 lesions (6.7%). Macroscopically and by probing, 12 lesions (40%) had intact smooth surface, 17 lesions (56.7%) had fibrillated surface and 1 lesion (3.3%) had small, scattered fissures. A negative correlation was found between the overall repair assessment score and the defect size (r² = - 0.430, p = 0.046) and between integration into border zone and defect size (r² = - 0.340, p = 0.045). A positive correlation was found between macroscopic appearance and age (r² = + 0.384, p = 0.036).

Conclusions: All-arthroscopic ACI using chondrospheres^® (ACT3D) for full-thickness retropatellar articular cartilage defects proved to be reproducible and reliable. The advantage of the procedure is that it is minimal invasive. Arthroscopic second-look demonstrated a high grade of normal or nearly normal cartilage regeneration. Although statistically significant differences were not observed, larger defect size and younger age may compromise the result of overall repair.

Level of evidence: III.

Keywords: ACI; Autologous chondrocyte implantation; Cartilage defect; Patella; Retropatellar; Second-look arthroscopy; Spheroid.

MeSH terms

Arthroscopy / methods
Cartilage Diseases* / pathology
Cartilage Diseases* / surgery
Cartilage, Articular* / pathology
Cartilage, Articular* / surgery
Chondrocytes / pathology
Humans
Patella
Transplantation, Autologous / methods
Treatment Outcome