Brittberg and colleagues tested whether cultured autologous chondrocytes, implanted under a periosteal flap, could repair full‑thickness cartilage defects of the knee.
Case series of 23 patients aged 14 to 48 with knee cartilage defects of 1.6 to 6.5 cm², followed 16 to 66 months (mean 39).
Methods
Indication
Full‑thickness knee cartilage defects of 1.6 to 6.5 cm²
Ages 14 to 48
16 femoral condylar defects
7 patellar defects
Approach
Arthroscopic chondrocyte harvest
Laboratory culture
Cell implantation under a periosteal flap
Outcomes
Clinical grade by explicit criteria
Arthroscopic appearance and firmness on probing
Biopsy histology of the transplant
Follow-up
16 to 66 months (mean 39)
Key Findings
Femoral condylar transplants gave good‑to‑excellent results in 14 of 16 patients at 2 years.
Patellar transplants did worse, with 2 of 7 patients rated excellent or good, 3 fair and 2 poor at a mean of 36 months.
Biopsies looked like hyaline cartilage in 11 of 15 femoral transplants vs 1 of 7 patellar transplants.
Second operations were needed in 2 femoral patients for severe central wear with locking and pain, and in 2 patellar patients for severe chondromalacia.
At 3 months the grafts sat level with surrounding tissue but were spongy with visible borders, and at second‑look arthroscopy many were firmer and resembled the adjacent cartilage.
Early after transplantation, locking resolved and pain and swelling decreased in every patient.
Board pearl
Repair tissue from the reparative techniques of the time is disorganized fibrocartilage built of type I collagen, which cannot restore the mechanics of normal articular cartilage.
Authors' conclusion
Cultured autologous chondrocytes can be used to repair deep cartilage defects in the femorotibial articular surface of the knee joint.
Brittberg and colleagues tested whether cultured autologous chondrocytes, implanted under a periosteal flap, could repair full‑thickness cartilage defects of the knee.
Case series of 23 patients aged 14 to 48 with knee cartilage defects of 1.6 to 6.5 cm², followed 16 to 66 months (mean 39).
Methods
Indication
Full‑thickness knee cartilage defects of 1.6 to 6.5 cm²
Ages 14 to 48
16 femoral condylar defects
7 patellar defects
Approach
Arthroscopic chondrocyte harvest
Laboratory culture
Cell implantation under a periosteal flap
Outcomes
Clinical grade by explicit criteria
Arthroscopic appearance and firmness on probing
Biopsy histology of the transplant
Follow-up
16 to 66 months (mean 39)
Key Findings
Femoral condylar transplants gave good‑to‑excellent results in 14 of 16 patients at 2 years.
Patellar transplants did worse, with 2 of 7 patients rated excellent or good, 3 fair and 2 poor at a mean of 36 months.
Biopsies looked like hyaline cartilage in 11 of 15 femoral transplants vs 1 of 7 patellar transplants.
Second operations were needed in 2 femoral patients for severe central wear with locking and pain, and in 2 patellar patients for severe chondromalacia.
At 3 months the grafts sat level with surrounding tissue but were spongy with visible borders, and at second‑look arthroscopy many were firmer and resembled the adjacent cartilage.
Early after transplantation, locking resolved and pain and swelling decreased in every patient.
Board pearl
Repair tissue from the reparative techniques of the time is disorganized fibrocartilage built of type I collagen, which cannot restore the mechanics of normal articular cartilage.
Authors' conclusion
Cultured autologous chondrocytes can be used to repair deep cartilage defects in the femorotibial articular surface of the knee joint.