[Treatment of deep chondral defects of the knee using autologous chondrocytes cultured on a support--results after one year].

PURPOSE OF THE STUDY: The treatment of deep chondral defects is one of the key issues in current orthopedics and traumatology. We developed a new technique that greatly improved the outcome of treatment in young active patients. The method is based on transplantation of in vitro cultured autologous chondrocytes carried on the fibrin glue Tissucol.

MATERIAL: In the years 2000 to 2002, 19 patients with deep chondral defects were treated by chondrocyte transplantation with the use of Tissucol. At 1 year, 14 defects (average size, 4.31 cm2; range, 2.0 to 10.0 cm2) in 12 patients were evaluated. The defects were localized on the weight-bearing areas of the femoral condyle, tibial plateau and femoropatellar joint in 10, one and three patients, respectively.

METHODS: The Lysholm knee score and IKDC subjective score were used for outcome evaluation. Second-look arthroscopy and repair assessment, on the basis of ICRS, were carried out in four patients.

RESULTS: The patients were examined at 5 and 12 months after surgery. The average value of the Lysholm knee score before surgery was 45.6 points and those at 5 and 12 months after surgery were 72.0 points and 81.5 points, respectively. Good or excellent outcomes were achieved in seven patients. The average preoperative IKDC subjective score was 39.0 points and the postoperative values were 60.0 and 71.2 points at 5 and 12 months, respectively. Second-look arthroscopy was performed in four patients at 3 to 5 months after the transplantation. A very good, complete healing of the graft was observed in two patients and partial chondrograft degeneration (30% graft area) was seen in two patients. The graft surfaces were evaluated according to the cartilage repair assessments system (ICSR-cartilage score) and the average value obtained was 8.5 points, i.e., almost a normal graft surface. During the second-look arthroscopy, samples for examination by light and electron microscopy were collected. In the healing defects, they showed the presence of hyaline-like cartilage characterized by typical spherical chondrocytes, extracellular collagenous filaments and formation of typical isogenetic cell groups. In the regions of graft degeneration (fissuration), neovascularization of the issue with the presence of fibroblast-like cells was recorded.

DISCUSSION: Excellent and very good outcomes were observed in 58% of our patients. Similar studies reported excellent and good results in 80 to 85% of the patients. On comparison, our group included more serious cases with the high presence of severe concomitant injuries, which influenced the final outcome. However, improvement was achieved in all 12 evaluated patients.

CONCLUSIONS: The method described is effective for treating deep chondral knee injuries and can be recommended for use in clinical practice.