Use of a cell-free collagen type-I matrix for the - Arthro

Klinik für Orthopädie und Rheumatologie
Direktorin: Univ.-Prof. Dr. Susanne Fuchs-Winkelmann
Universitätsklinikum Gießen und Marburg, Standort Marburg
62nd Annual Meeting of the Association of South German
orthopedic surgeons e.V.
Use of a cell-free collagen type-I matrix for the
therapy of larger cartilage defects of knee
joints
Schüttler KF, Pfister B, Struewer J, Roessler PP, FuchsWinkelmann S, Efe T
Cartilage Lesions
Cartilage lesions of the knee joint are are
often
•  43%
of all arthroskopies
(Figueroa D, 2007 Arthroscopy)
•  61%
of all arthroskopies
(Hjelle K, 2002 Arthroscopy)
•  66%
of all arthroskopies
(Aaron A, 2004 Am J Sport Med)
Surgical Options
Stimulation
Repair
1. Generation
Regeneration
2..Generation
Stimulation
2.and.
3..Generation
Regeneration
Mikrofrakture,
Pridie-Drilling,
Abrasion
OsteochondralImplantation
(OATS)
Autologeous
Chondrocyte
Implantation (ACI)
Autologeous
Matrix-Induced
Chondrogenesis
(AMIC)
Collagen-covered
ACI (C-ACI), 2nd
Generation
fibrocartilage
donor defect
Next Generation?:
Cell-free implants
CaReS-1S®; GelrinC®
Matrix-Induced
ACI (MACI) 3rd
Generation
two-stage,
periosteal
hypertrophy
fibrocartilage,
Osseous
hypertrophy
Two-stage
Decision on the defect size
MACI
AMIC
Method
Cell-free Implants
OATS
Microfracture
0cm2 1cm2 2cm2 3cm2 4cm2 5cm2 6cm2 7cm2 8cm2
Defect Size
Matrix
• 
• 
• 
• 
Cell-free collagen type-I matrix
4,8mg/ml collagen type-I, in PBS stired at 2-25°C
CaReS-1S®, ArthroKinetics, Austria
Previously been used successfully as a matrix
within the MACT (CaReS) (Andereya S, 2006 Z Orthop Ihre
Grenzgeb.)
Cell-free – which defect size is
possible?
?
?
Cartilage
Cartilage
Cell-free
matrix
?
?
Bone
?
?
Morales TI, 2007 Osteoarthritis Cartilage
Prospective case series
–  Implantation of the matrix after previous ASK using a
mini-arthrotomy
–  22 patients treated with a collagen type-I matrix
(6 female; 16 male; average age: 32 years)
Clinical examination after 3, 6, 12 months
–  Clinical evaluation by SF-36 and IKDC score
(SF-36: Tarlov AR, 1989 JAMA; IKDC: Irrgang JJ, 2001 Am J Sports Med)
Radiological examination after 6, 12 months
–  Evaluation of the regenerated tissue by MRI
(MOCART score; Marlovits S, 2006 Eur J Radiol)
Inclusion criteria
•  Inclusion criteria:
–  preserved cartilage shoulder
–  corresponding intact articular surface
(no „kissing-lesions“)
–  intact menisci and ligaments
–  physiological leg axis
–  free ROM
–  Defects acc. to ICRS: grade III and IV
Patients
•  Mean defect size: 4,33cm2 (2cm2 - 6,25cm2)
•  Defect localization:
–  19x femoral condyle; 3x patellofemoral
•  solitary defects
•  15x caused by trauma, 5x OD, 2x idiopathic
•  all patients were followed up
•  no perioperative complications
Results I
•  subjective satisfaction:
–  80% (18/22 patients) „good“ und „excellent“
SF-­‐‑36 mentally
70
*
60
*
SF-­‐‑36 physically
*
50
*
50
*
*
40
40
30
30
20
20
10
10
0
60
präoperativ
3 Monate
6 Monate
12 Monate
0
* p < 0,05
präoperativ
3 Monate
6 Monate
12 Monate
Results II
IKDC
70
*
60
*
50
40
30
20
10
0
präoperativ
3 Monate
6 Monate
12 Monate
Results III
•  MOCART score:
–  6 months postoperative 52 / 100
–  12 months postoperative 59 / 100
•  Complete filling of the defects in 20 of 22 patients
•  1 patient with incomplete integration to border zone
•  1 patient with incomplete filling of the defect (hypothroph)
•  No evidence of infection, synovitis
Limitations of the study
•  no control group
•  current follow-up until 1 year
•  small collective
•  Where are the cells derived from?
Summary
•  The implantation of a cell-free collagen type I
matrix results in good to very good results 12
months postoperatively
•  Also defects of a size up to 6.25 cm2 can be
successfully treated with cell-free implants