Cartilage Surgery in Overweight Patients: Clinical and MRI Results after the Autologous Matrix-Induced Chondrogenesis Procedure.

Matthias Lahner,Nina Lahner,Wolfram Teske,Kiriakos Daniilidis,Christopher Ull,Marco Hagen,Lars Victor von Engelhardt,Christoph von Schulze Pellengahr

doi:10.1155/2018/6363245

Abstract

Modern orthopaedic surgery provides a variety of techniques for cartilage repair. The Autologous Matrix-Induced Chondrogenesis (AMIC) procedure is a single-step technique with a collagen I/III scaffold for the treatment of full-thickness cartilage lesions. The aim of the study was to analyze the outcome of the AMIC procedure in overweight patients with knee cartilage defects. Overweight patients treated with AMIC surgery were followed up by clinical and MRI examination. 9 patients with a cartilage defect of the knee with a mean lesion size of 2.1 ± 1.2 cm2 and an average body mass index (BMI) of 29.3 were available for the follow-up. The Lysholm Score was significantly improved by the AMIC procedure (38 to 67, p ≤ 0.008). The VAS Score was significantly lower after the procedure (9 to 3, p ≤ 0.018). In the postoperative MOCART Scale, the scaffold reached defect covering of 80%. However, 2 patients had to be revised due to persisting knee pain. The AMIC procedure enhances pain reduction and gain of knee function for cartilage defects of overweight patients. However, in cases of an increased BMI, the patient had to be informed that success rate is reduced despite good defect covering.

Highlights

Orthopaedic researchers have established innovative regenerative techniques for the treatment of cartilage damage [1, 2]
Many surgical techniques were developed for coating focal cartilage joint lesions
During March 2009 and February 2010, all patients presenting with nontraumatic knee pain, with a clinical unilateral symptomatic chondral lesions grades III-IV to Outerbridge [9] after failed conservative treatment of at least 6 months and a body mass index (BMI) > 25, were considered to be study participant

Summary

Introduction

Orthopaedic researchers have established innovative regenerative techniques for the treatment of cartilage damage [1, 2]. Many surgical techniques were developed for coating focal cartilage joint lesions. Current available surgical cartilage treatments include lavage and debridement, subchondral penetration procedure (microfracture technique, drilling, or abrasion chondroplasty), osteochondral autologous transplantation (OAT), and autologous chondrocyte implantation (ACI) with or without using a scaffold [3,4,5,6]. The most used technique for a single-step procedure is the microfracture (Mfx), in which a penetration of the subchondral bone layer is performed with subsequent effluent of progenitor cells from the bone marrow into the articular cartilage lesion [3,4,5,6]. Scaffold-assisted single-step techniques were developed to enhance cartilage tissue regeneration by the combination of the Mfx with biomaterial [6]. Different matrices are currently available for cartilage surgery like scaffolds with porcine collagen I/III

Objectives

Methods

Results

Conclusion