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

All papers published in the Annals will be made free to access on our website after an embargo period of one year, with no paywalls or impediments to access. We will also deposit all articles in PubMed Central after the embargo period.

Copyright will remain with the RCS.

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

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