A cost-effective cell- and matrix-based minimally invasive single-stage chondroregenerative technique developed with validated vertical translation methodology.

Journal article


Shetty, A., Kim, S., Ahmed, S., Trattnig, S., Kim, S. and Jang, H. 2018. A cost-effective cell- and matrix-based minimally invasive single-stage chondroregenerative technique developed with validated vertical translation methodology. The Annals of the Royal College of Surgeons of England. 100 (3), pp. 240-246. https://doi.org/10.1308/rcsann.2017.0223
AuthorsShetty, A., Kim, S., Ahmed, S., Trattnig, S., Kim, S. and Jang, H.
Abstract

Introduction: The morbidity and significant health economic impact associated with the chondral lesion has led to a large number of strategies for therapeutic neochondrogenesis. The challenge has been to develop techniques that are cost effective single-stage procedures with minimal surgical trauma that have undergone rigorous preclinical scrutiny and robust reproducible assessment of effectiveness. A biological repair requires the generation of a cellular and matrix composite with appropriate signalling for chondrogenic differentiation.

Methods and Results: A technique was developed that allowed chondrogenic primary (uncultured) cells from bone marrow aspirate concentrate, combined with a composite hydrophilic and fibrillar matrix to be applied arthroscopically to a site of a chondral lesion. The construct was tested in vitro and in animal experiments before clinical trials.

Clinical trials involved 60 patients in a prospective study. Symptomatic International Cartilage Repair Society grade 3 and 4a lesions were mapped and treated. Pre- and postoperative clinical assessments showed statistically significant improved outcomes; Lysholm Knee Scoring Scale (mean 52.8 to > 76.4; P < 0.05) International Knee Documentation Committee (mean 39 to > 79 P < 0.05) and Knee injury and Osteoarthritis Outcome Score (64.5 to >89.2 P < 0.05). Postoperative magnetic resonance imaging was evaluated morphologically (magnetic resonance observation of cartilage repair tissue, average MOCART score 72) and qualitatively; the regenerate was comparable to native cartilage.

Conclusions: This technique is effective, affordable, requires no complex tools and delivers a single-stage treatment that is potentially accessible to any centre capable of performing arthroscopic surgery. Good clinical results were found to be sustained at five years of follow-up with a regenerate that appears hyaline like using multiple magnetic resonance measures.

KeywordsAdenoma; hyperplasia; primary hyperparathyroidism
Year2018
JournalThe Annals of the Royal College of Surgeons of England
Journal citation100 (3), pp. 240-246
PublisherRoyal College of Surgeons of England
ISSN0035-8843
Digital Object Identifier (DOI)https://doi.org/10.1308/rcsann.2017.0223
Official URLhttp://doi.org/10.1308/rcsann.2017.0223
Publication dates
Online01 Mar 2018
Publication process dates
Deposited20 Mar 2019
Accepted06 Nov 2017
Output statusPublished
Additional information

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Copyright will remain with the RCS.

Our Open Access policy is compliant with RCUK and Wellcome Trust guidelines.

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