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Autologous chondrocyte transplantation for reconstruction of isolated joint defects: the Assaf Harofeh experience.
Isr Med Assoc J. 2000 Apr; 2(4):290-5.IM

Abstract

BACKGROUND

Articular cartilage is incapable of undergoing self-repair since chondrocytes lose their mitotic ability as early as the first year of life. Defects in articular cartilage, especially in weight-bearing joints, will predictably deteriorate toward osteoarthritis. No method has been found to prevent this deterioration. Drilling of the subchondral bone can lead to fibrocartilage formation and temporary repair that slowly degrades. Animal experiments indicate that introducing proliferating chondrocytes such as cultured articular chondrocytes can reliably reconstruct joint defects.

OBJECTIVES

To describe our clinical experience in culturing and transplanting autologous chondrocytes.

METHODS

Biopsies were obtained from 10 patients, aged 18-45, undergoing a routine arthroscopy in which a cartilage defect was identified with indications for cartilage transplantation. The biopsies were further processed to establish chondrocyte cultures. ACT was performed in 8 of the 10 patients because of persistent symptoms for at least 2 months post-arthroscopy. All patients (6 men and 2 women) had a grade IV cartilage defect in the medial or lateral femoral condyle, and three had a defect in the trochlear region as well. Biopsies were removed from the lateral rim of the superior aspect of the femur, and cells were cultured in a clean room. Following a 2 order of magnitude expansion, cells were implanted under a periosteal flap.

RESULTS

The eight patients implanted with autologous cells were followed for 6 months to 5 years (average 1 year). Complaints of giving-way, effusion and joint locking resolved in all patients, and pain as assessed by the visual analogue score was reduced by an average of 50%. Follow-up magnetic resonance imaging studies in all patients revealed that the defects were filled with tissue having similar signal characteristics to cartilage.

CONCLUSIONS

Chondrocyte implantation is a procedure capable of restoring normal articular cartilage in cases with isolated joint defects. Pain can be predictably reduced, while joint locking and effusion are eliminated. The effect on osteoarthritis progression in humans has not yet been elucidated.

Authors+Show Affiliations

Department of Orthopedics, Assaf Harofeh Medical Center, Zerifin, Israel. robinsn@netvision.net.ilNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

10804905

Citation

Robinson, D, et al. "Autologous Chondrocyte Transplantation for Reconstruction of Isolated Joint Defects: the Assaf Harofeh Experience." The Israel Medical Association Journal : IMAJ, vol. 2, no. 4, 2000, pp. 290-5.
Robinson D, Ash H, Aviezer D, et al. Autologous chondrocyte transplantation for reconstruction of isolated joint defects: the Assaf Harofeh experience. Isr Med Assoc J. 2000;2(4):290-5.
Robinson, D., Ash, H., Aviezer, D., Agar, G., Halperin, N., & Nevo, Z. (2000). Autologous chondrocyte transplantation for reconstruction of isolated joint defects: the Assaf Harofeh experience. The Israel Medical Association Journal : IMAJ, 2(4), 290-5.
Robinson D, et al. Autologous Chondrocyte Transplantation for Reconstruction of Isolated Joint Defects: the Assaf Harofeh Experience. Isr Med Assoc J. 2000;2(4):290-5. PubMed PMID: 10804905.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Autologous chondrocyte transplantation for reconstruction of isolated joint defects: the Assaf Harofeh experience. AU - Robinson,D, AU - Ash,H, AU - Aviezer,D, AU - Agar,G, AU - Halperin,N, AU - Nevo,Z, PY - 2000/5/11/pubmed PY - 2000/6/8/medline PY - 2000/5/11/entrez SP - 290 EP - 5 JF - The Israel Medical Association journal : IMAJ JO - Isr Med Assoc J VL - 2 IS - 4 N2 - BACKGROUND: Articular cartilage is incapable of undergoing self-repair since chondrocytes lose their mitotic ability as early as the first year of life. Defects in articular cartilage, especially in weight-bearing joints, will predictably deteriorate toward osteoarthritis. No method has been found to prevent this deterioration. Drilling of the subchondral bone can lead to fibrocartilage formation and temporary repair that slowly degrades. Animal experiments indicate that introducing proliferating chondrocytes such as cultured articular chondrocytes can reliably reconstruct joint defects. OBJECTIVES: To describe our clinical experience in culturing and transplanting autologous chondrocytes. METHODS: Biopsies were obtained from 10 patients, aged 18-45, undergoing a routine arthroscopy in which a cartilage defect was identified with indications for cartilage transplantation. The biopsies were further processed to establish chondrocyte cultures. ACT was performed in 8 of the 10 patients because of persistent symptoms for at least 2 months post-arthroscopy. All patients (6 men and 2 women) had a grade IV cartilage defect in the medial or lateral femoral condyle, and three had a defect in the trochlear region as well. Biopsies were removed from the lateral rim of the superior aspect of the femur, and cells were cultured in a clean room. Following a 2 order of magnitude expansion, cells were implanted under a periosteal flap. RESULTS: The eight patients implanted with autologous cells were followed for 6 months to 5 years (average 1 year). Complaints of giving-way, effusion and joint locking resolved in all patients, and pain as assessed by the visual analogue score was reduced by an average of 50%. Follow-up magnetic resonance imaging studies in all patients revealed that the defects were filled with tissue having similar signal characteristics to cartilage. CONCLUSIONS: Chondrocyte implantation is a procedure capable of restoring normal articular cartilage in cases with isolated joint defects. Pain can be predictably reduced, while joint locking and effusion are eliminated. The effect on osteoarthritis progression in humans has not yet been elucidated. SN - 1565-1088 UR - https://www.unboundmedicine.com/medline/citation/10804905/Autologous_chondrocyte_transplantation_for_reconstruction_of_isolated_joint_defects:_the_Assaf_Harofeh_experience_ DB - PRIME DP - Unbound Medicine ER -