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Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture

Daniel BF Saris, Johan Vanlauwe, Jan Victor UGent, Miroslav Haspl, Michael Bohnsack, Yves Fortems, Bruno Vandekerckhove, Karl Almqvist UGent, Toon Claes and Frank Handelberg, et al. (2008) AMERICAN JOURNAL OF SPORTS MEDICINE. 36(2). p.235-246
abstract
Background: As the natural healing capacity of damaged articular cartilage is poor, joint surface injuries are a prime target for regenerative medicine. Characterized chondrocyte implantation uses an autologous cartilage cell therapy product that has been optimized for its biological potency to form stable cartilage tissue in vivo. Purpose: To determine whether, in symptomatic cartilage defects of the femoral condyle, structural regeneration with characterized chondrocyte implantation is superior to repair with microfracture. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Characterized chondrocyte implantation was compared with microfracture in patients with single grade III to IV symptomatic cartilage defects of the femoral condyles in a multicenter trial. Patients aged 18 to 50 years were randomized to characterized chondrocyte implantation (n = 57) or microfracture (n = 61). Structural repair was blindly assessed in biopsy specimens taken at 1 year using (1) computerized histomorphometry and (2) evaluation of overall histological components of structural repair. Clinical outcome was measured using the self administered Knee injury and Osteoarthritis Outcome Score. Adverse events were recorded throughout the study. Results: Characterized chondrocyte implantation resulted in better structural repair, as assessed by histomorphometry (P =.003) and overall histologic evaluation (P =.012). Aspects of structural repair relating to chondrocyte phenotype and tissue structure were superior with characterized chondrocyte implantation. Clinical outcome as measured by the Knee injury and Osteoarthritis Outcome Score at 12 to 18 months after characterized chondrocyte implantation was comparable with microfracture at this stage. Both treatment groups had a similar mean baseline overall Knee injury and Osteoarthritis Outcome Score (56.30 +/- 13.61 and 59.53 +/- 14.95 for microfracture and characterized chondrocyte implantation, respectively), which increased in both groups to 70.56 +/- 12.39 and 72.63 +/- 15.55 at 6 months, 73.26 +/- 14.66 and 73.10 +/- 16.01 at 12 months, and 74.73 +/- 17.01 and 75.04 +/- 14.50 at 18 months, respectively. Both techniques were generally well tolerated; the incidence of adverse events after characterized chondrocyte implantation was not markedly increased compared with that for microfracture. Conclusion: One year after treatment, characterized chondrocyte implantation was associated with a tissue regenerate that was superior to that after microfracture. Short-term clinical outcome was similar for both treatments. The superior structural outcome may result in improved long-term clinical benefit with characterized chondrocyte implantation. Long-term follow-up is needed to confirm these findings.
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author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
chondral, chondrocyte, regenerative medicine, autologous chondrocyte implantation (ACI), characterized chondrocyte implantation (CCI), cell therapy product, microfracture, cartilage repair, THICKNESS CHONDRAL DEFECTS, HUMAN ARTICULAR-CARTILAGE, IN-VIVO, TRANSPLANTATION, TISSUE, REHABILITATION, OSTEOARTHRITIS, ARTHROSCOPIES, DEBRIDEMENT, INJURY
journal title
AMERICAN JOURNAL OF SPORTS MEDICINE
Am. J. Sports Med.
volume
36
issue
2
pages
235 - 246
Web of Science type
Article
Web of Science id
000252663900002
JCR category
SPORT SCIENCES
JCR impact factor
3.646 (2008)
JCR rank
2/71 (2008)
JCR quartile
1 (2008)
ISSN
0363-5465
DOI
10.1177/0363546507311095
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
434016
handle
http://hdl.handle.net/1854/LU-434016
date created
2008-10-30 11:45:00
date last changed
2011-12-15 14:51:36
@article{434016,
  abstract     = {Background: As the natural healing capacity of damaged articular cartilage is poor, joint surface injuries are a prime target for regenerative medicine. Characterized chondrocyte implantation uses an autologous cartilage cell therapy product that has been optimized for its biological potency to form stable cartilage tissue in vivo. 
Purpose: To determine whether, in symptomatic cartilage defects of the femoral condyle, structural regeneration with characterized chondrocyte implantation is superior to repair with microfracture. 
Study Design: Randomized controlled trial; Level of evidence, 1. 
Methods: Characterized chondrocyte implantation was compared with microfracture in patients with single grade III to IV symptomatic cartilage defects of the femoral condyles in a multicenter trial. Patients aged 18 to 50 years were randomized to characterized chondrocyte implantation (n = 57) or microfracture (n = 61). Structural repair was blindly assessed in biopsy specimens taken at 1 year using (1) computerized histomorphometry and (2) evaluation of overall histological components of structural repair. Clinical outcome was measured using the self administered Knee injury and Osteoarthritis Outcome Score. Adverse events were recorded throughout the study. 
Results: Characterized chondrocyte implantation resulted in better structural repair, as assessed by histomorphometry (P =.003) and overall histologic evaluation (P =.012). Aspects of structural repair relating to chondrocyte phenotype and tissue structure were superior with characterized chondrocyte implantation. Clinical outcome as measured by the Knee injury and Osteoarthritis Outcome Score at 12 to 18 months after characterized chondrocyte implantation was comparable with microfracture at this stage. Both treatment groups had a similar mean baseline overall Knee injury and Osteoarthritis Outcome Score (56.30 +/- 13.61 and 59.53 +/- 14.95 for microfracture and characterized chondrocyte implantation, respectively), which increased in both groups to 70.56 +/- 12.39 and 72.63 +/- 15.55 at 6 months, 73.26 +/- 14.66 and 73.10 +/- 16.01 at 12 months, and 74.73 +/- 17.01 and 75.04 +/- 14.50 at 18 months, respectively. Both techniques were generally well tolerated; the incidence of adverse events after characterized chondrocyte implantation was not markedly increased compared with that for microfracture. 
Conclusion: One year after treatment, characterized chondrocyte implantation was associated with a tissue regenerate that was superior to that after microfracture. Short-term clinical outcome was similar for both treatments. The superior structural outcome may result in improved long-term clinical benefit with characterized chondrocyte implantation. Long-term follow-up is needed to confirm these findings.},
  author       = {Saris, Daniel BF and Vanlauwe, Johan and Victor, Jan and Haspl, Miroslav and Bohnsack, Michael and Fortems, Yves and Vandekerckhove, Bruno and Almqvist, Karl and Claes, Toon and Handelberg, Frank and Lagae, Koen and van der Bauwhede, Jan and Vandenneucker, Hilde and Yang, K Gie Auw and Jelic, Mislav and Verdonk, Ren{\'e} and Veulemans, Nancy and Bellemans, Johan and Luyten, Frank P},
  issn         = {0363-5465},
  journal      = {AMERICAN JOURNAL OF SPORTS MEDICINE},
  keyword      = {chondral,chondrocyte,regenerative medicine,autologous chondrocyte implantation (ACI),characterized chondrocyte implantation (CCI),cell therapy product,microfracture,cartilage repair,THICKNESS CHONDRAL DEFECTS,HUMAN ARTICULAR-CARTILAGE,IN-VIVO,TRANSPLANTATION,TISSUE,REHABILITATION,OSTEOARTHRITIS,ARTHROSCOPIES,DEBRIDEMENT,INJURY},
  language     = {eng},
  number       = {2},
  pages        = {235--246},
  title        = {Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture},
  url          = {http://dx.doi.org/10.1177/0363546507311095},
  volume       = {36},
  year         = {2008},
}

Chicago
Saris, Daniel BF, Johan Vanlauwe, Jan Victor, Miroslav Haspl, Michael Bohnsack, Yves Fortems, Bruno Vandekerckhove, et al. 2008. “Characterized Chondrocyte Implantation Results in Better Structural Repair When Treating Symptomatic Cartilage Defects of the Knee in a Randomized Controlled Trial Versus Microfracture.” American Journal of Sports Medicine 36 (2): 235–246.
APA
Saris, D. B., Vanlauwe, J., Victor, J., Haspl, M., Bohnsack, M., Fortems, Y., Vandekerckhove, B., et al. (2008). Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. AMERICAN JOURNAL OF SPORTS MEDICINE, 36(2), 235–246.
Vancouver
1.
Saris DB, Vanlauwe J, Victor J, Haspl M, Bohnsack M, Fortems Y, et al. Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. AMERICAN JOURNAL OF SPORTS MEDICINE. 2008;36(2):235–46.
MLA
Saris, Daniel BF, Johan Vanlauwe, Jan Victor, et al. “Characterized Chondrocyte Implantation Results in Better Structural Repair When Treating Symptomatic Cartilage Defects of the Knee in a Randomized Controlled Trial Versus Microfracture.” AMERICAN JOURNAL OF SPORTS MEDICINE 36.2 (2008): 235–246. Print.