Matrix assisted autologous chondrocyte transplantation: long term results and prognostic factors

Objectives: Aim of this study is to evaluate the long term results of
matrix-assisted autologous chondrocyte transplantation on a biodegradable
hyaluronian-based biocompatible scaffold (Hyalograft C).
Methods: 60 patients (41 men, 19 women; mean age: 29.8 yy, mean
lesion size: 2.5 cm2) affected by knee chondral lesions, were enrolled
and treated by the implantation of a hyaluronic acid based bioengineered
tissue. Lesions were located at medial femoral condyle (34),
lateral femoral condyle (19), throclea (7) and tibial plateau (2). The
surgical technique consisted in two arthroscopic steps and all the
patients were evaluated prospectively yearly for up to 10 years of
follow-up. Evaluation tools employed were: IKDC, EQ-VAS, and
Tegner scores. Complications, failures, and patient satisfaction were
also documented.
Results: Significant increases in all clinical scores were registered
over time after chondrocyte implantation. IKDC-subjective score
raised from 39.0 to 75.9 after 24 months (p\0.05) and results
remained stable up to the final evaluation at 10 years’ follow-up
(71.1; p\0.05). The same trend was registered in EQ-VAS
which passed from 60/100 pre-operatively to 81/100 at 2 years’ follow
up and finally reached 70/100 at 10 years. Tegner score
also increased from a basal value of 2–5 after 2 years of follow-up,
and it remained stable over time, even if the sport activity level registered
at the last evaluation was significantly lower than pre-injury
(4.5 vs 7; p\0.05). No major adverse events were reported.
Conclusions: Autologous chondrocyte transplantation on a hyaluronan
based matrix is a safe and effective technique for the treatment of
medium size chondral defects. Clinical outcome is satisfying and
stable at long term-evaluation and the entirely arthroscopic approach
is able to minimize the surgical stress for the patient.