Title: Articular Cartilage Engineering with Hylograft® C: 3-year Clinical Results
Authors: Marcacci MD, et al.
Source: Clinical Orthopaedics and Related Research 2005; vol. 435: 96-105.
PODIATRIC RELEVANCE:
Articular cartilage damage is commonly seen in the podiatric practice. Contributing factors include: microtrauma such as DJD, chronic metabolic diseases, and mechanical injury such trauma leading to osteochondral defects (OCD). The use of Hylograft®, tissue engineered graft composed of autologus chondrocyte grown on a three dimensional nonwoven scaffold, HYAFF® 11, could be considered for potential treatment options for osteochondral lesions in the foot and ankle.
METHODS:
A clinical study investigating the subjective symptomatic, functional and health related quality of life of 235 cartilage defects in 192 patients treated with a tissue engineered graft, Hyalograft® C. The autologous chondrocyte was isolated from a cartilage biopsy harvested from a non-weight bearing area of the knee, cultured for 14 days in an esterified derivative of hyloraunic acid, HYAFF ®11. The graft is then implanted at the lesion site by mini-arthrotomy or through arthroscopy.
Patients answered questions based of 3 different questionnaires: International Cartilage Repair Society (ICRS) knee functional status, International Knee Documentation Committee (IKDC) subjective evaluation of knee symptoms, function and activity level and EuroQol EQ-5D for quality of life assessment.
The total patient population consisted of 192 patients with knee lesions, of which 141 patients had follow up of at least 24 months, 30.3 % with caused by trauma, 9% with OCD lesion and 60.0% had lesions secondary to microtrauma and/or degenerative in nature. The mean surface area implanted per patient was 3.5cm2 which was applied to the defect without any fixation method in 55.1% of cases, fibrin glue in 29.3% of the time and sutures alone in 11.1% of cases. Fifty five patients were also followed post-grafting for evaluation of integration of graft to the border zone and macroscopic appearance of newly formed tissue, 22 of those were biopsied to histologically asses the tissue. There were no exclusion criteria.
RESULTS:
Functionally, 71.4 % of patients reported they could do everything or nearly everything that they wanted to do with their joint. Higher IKDC (>82 points) scores were obtained by patients with lesions caused by trauma and OCD. Using the EQ-5D questionnaire, 86.4 % of patients noted improved quality of life. Histological analysis of the biopsies, revealed hyaline-like core in 12 of the 22 and 4 with fibrocartilage appearance, with a mean time of 15.2 months after implantation. None of the biopsies harvested at 18 months were classified as fibrocartilage. Overall 9 patients reported complications; three had post-op fevers, one had arthrosynovitis and one was found to have osteonecrosis under the graft.
COMMENTS:
As surgeons, we should always look to restore mobility and functionality of joints. This article explores therapeutic alternatives to traditional surgical methods for cartilage repair. Hyalograft C® has shown positive results with 91.5% of patients reporting subjective improvements in knee symptoms, functionality and activity level, regardless of lesion size or location.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.