| PurposeTo investigate the clinical,radiological,and histological results of the matrix associated with autologous chondrocytes(MACI)in the treatment chondral lesions of the knee.MethodsThe study prospectively enrolled 10 patients with symptomatic knee chondral lesions(mean size defect was 2.43±0.47 cm~2,range 2.0 to 3.2 cm~2)on the lateral femoral condyle,medial femoral condyle,and femoral groove undergoing autologous chondrocyte combined with type I collagen scaffold between June 2018 and February 2019.The knee injury and osteoarthritis outcome score,IKDC score,and Lysholm score were assessed preoperatively,and the periodic clinical follow-up was performed preoperatively,and then at every 3 months for up to 12 months postoperative period,and thereafter at 1-year intervals.During this follow-up,serial magnetic resonance imaging T2 mapping of repair cartilage was used to reflect the quantitative analysis quality of the regenerative cartilage.In one patient,second-look arthroscopy was performed at 12 months after implantation to assess the status of treated cartilage,and it harvested a portion of regenerated cartilage for histologic evaluation.ResultsCompared with the preoperation,the KOOS pain(16.39±9.21 vs 55.83±12.32、71.39±7.86、78.33±6.52、87.50±4.39,F=108.42,p<0.05),symptoms(40.36±18.06 vs 50.50±10.25、76.50±11.84、72.14±13.76、86.07±4.90,F=20.02,p<0.05),activities of daily living(76.91±6.20 vs 81.47±4.81、86.77±2.41、89.41±2.48、93.68±2.20,F=27.71,p<0.05),Sports&Rec(27.00±7.15 vs 37.50±12.96、56.50±15.64、61.50±8.83、80.50±5.99,F=37.40,p<0.05),and quality of life(24.38±13.96 vs38.75±12.77、51.25±9.22、58.13±18.17、74.38±9.06,F=21.08,p<0.05)showed significant improvement at 3,6,12 and 24 months after surgery.Except for 12 months after surgery and 6 months after surgery,the difference in scores between every two time points was statistically significant(p<0.001).T2 mapping at 3,6,12 and 24 months after surgery analysis showed that the intensity of regenerative cartilage and the intensity of surrounding cartilage gradually tended to the same level(83.70±1.59、78.70±1.59、42.70±4.32、34.50±1.51 vs 29.30±2.26)and the T2 value was statistically significant compared with the surrounding normal cartilage between every two time points(F=430.00,p<0.05).As shown in the HE stains of the biopsy specimen of one patient,the newly formed cartilage was naive chondrocytes in the shape of the round or oval,mature chondrocytes looking flattered relative to more basal zones in the superficial area and more spheroidal in the transitional or middle zone.Safranin O-fast green stain manifested the superficial zone of the repair tissue comprising predominantly spindle-shaped fibroblast-like cells surrounded by glycosaminoglycans.Immunohistochemistry analysis showed that the expression of collagen type II was more clear and evenly distributed than collagen type I.ConclusionShort-term follow-up in our case series found matrix associated autologous chondrocyte implantation was an effective method to improve function and pain.HE staining,SO staining,and IHC of the biopsy of one patient had confirmed that this method could regenerate hyaline cartilage in cartilage lesions,but the regenerated tissue was still immature.Similarly,T2mapping quantitative analysis also showed that there were differences between regenerated cartilage and surrounding hyaline cartilage. |
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