Matrix-associated chondrocyte transplantation for reconstruction of articulating surfaces in the temporomandibular joint: a pilot study covering medium- and long-term outcomes of 6 patients

Gerhard Undt,Michael Jahl,Sebastian Pohl,Stefan Marlovits,Doris Moser,Hyang-Hee Yoon,Jimmy Frank,Susanna Lang,Christian Czerny,Guenter Klima,Eileen Gentleman,Rolf Ewers

doi:10.1016/j.oooo.2018.02.017

Abstract

ObjectiveMatrix-associated chondrocyte transplantation is routinely used in joints of the extremities but not in the temporomandibular joint (TMJ).Study DesignWe report the first case series in 7 patients of a tissue engineering approach to regenerate severely degraded articulating surfaces in the TMJ by simultaneously completely resurfacing both the mandibular condyle and the articular eminence/glenoid fossa with a commercially available collagen sponge seeded with autologous cells stabilized within a fibrin matrix. To facilitate healing, we temporarily employed a silicone membrane to protect the engineered tissues. The indications for surgery were posttraumatic fibro-osseous ankylosis, ankylosing osteoarthritis, or late-stage osteoarthritis.ResultsSix of the patients were recalled for follow-up after 3 years 6 months to 12 years 1 month. The maximum incisal opening was 18.2 ± 9.2 mm (range, 9-33 mm) before and 31.2 ± 13.6 mm (range, 12-47 mm) at the latest follow-up. Histologic specimens taken at 4 months showed beginning differentiation of fibrocytes into chondrocytes, whereas at 3 and 11 years, mature hyaline cartilage—not typical for the TMJ—was present.ConclusionsWe conclude that the reconstruction of TMJ surfaces by matrix-associated chondrocyte transplantation may become a routine method for cartilage regeneration in the TMJ in the future.

Highlights

Adopting an approach for tissue regeneration that has been successfully applied in other joints might be a step forward in biological temporomandibular joint (TMJ) reconstruction, and so we report here a case series of 7 patients treated with matrix-associated chondrocyte transplantation (MACT) to repair severely degraded articulating surfaces of the TMJ
The most important clinical criterion for assessing a favorable outcome in patients who undergo TMJ reconstruction is a good range of mouth opening
Ten Gy were applied to each side, and the patient maintained an Maximum incisal opening (MIO) of >25 mm for 2 years (Figure 3). When her MIO went down to 20 mm 4 years after MACT surgery (2007), we proposed an alloplastic reconstruction of both joints

Summary

Objective

Matrix-associated chondrocyte transplantation is routinely used in joints of the extremities but not in the temporomandibular joint (TMJ). There have been reports about foreign-body reactions, alloplastic materials are still used for the permanent separation of free bone surfaces after gap arthroplasty.[15] Alloplastic total joint reconstruction is the gold standard for treatment of TMJ re-ankylosis in the case of multiple failed previous surgeries or systemic disease.[7] The potential disadvantages of alloplastic reconstruction relate to metal hypersensitivities and to degradation or failure of the material after more than 15 to 20 years.[16] a risk of 1.5% for early and late infections of alloplastic TMJ devices has been reported.[17] researchers and surgeons have been seeking new biological methods of TMJ reconstruction.[18,19] The first use of the MACT technique in the TMJs of patients with osteoarthritis was mentioned by Professor Michael Rasse (Wels, Austria, personal communication 2003); no reports far have appeared in the literature. Adopting an approach for tissue regeneration that has been successfully applied in other joints might be a step forward in biological TMJ reconstruction, and so we report here a case series of 7 patients treated with MACT to repair severely degraded articulating surfaces of the TMJ

MATERIALS AND METHODS

RESULTS

DISCUSSION