N Engl J Med. 1994 Oct 6;331(14):889-95.
Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.
Brittberg M1, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L.
Department of Orthopedic Surgery, University of Göteborg, Sahlgrenska University Hospital, Sweden.
Full-thickness defects of articular cartilage in the knee have a poor capacity for repair. They may progress to osteoarthritis and require total knee replacement. We performed autologous chondrocyte transplantation in 23 people with deep cartilage defects in the knee.
The patients ranged in age from 14 to 48 years and had full-thickness cartilage defects that ranged in size from 1.6 to 6.5 cm2. Healthy chondrocytes obtained from an uninvolved area of the injured knee during arthroscopy were isolated and cultured in the laboratory for 14 to 21 days. The cultured chondrocytes were then injected into the area of the defect. The defect was covered with a sutured periosteal flap taken from the proximal medial tibia. Evaluation included clinical examination according to explicit criteria and arthroscopic examination with a biopsy of the transplantation site.
Patients were followed for 16 to 66 months (mean, 39). Initially, the transplants eliminated knee locking and reduced pain and swelling in all patients. After three months, arthroscopy showed that the transplants were level with the surrounding tissue and spongy when probed, with visible borders. A second arthroscopic examination showed that in many instances the transplants had the same macroscopic appearance as they had earlier but were firmer when probed and similar in appearance to the surrounding cartilage. Two years after transplantation, 14 of the 16 patients with femoral condylar transplants had good-to-excellent results. Two patients required a second operation because of severe central wear in the transplants, with locking and pain. A mean of 36 months after transplantation, the results were excellent or good in two of the seven patients with patellar transplants, fair in three, and poor in two; two patients required a second operation because of severe chondromalacia. Biopsies showed that 11 of the 15 femoral transplants and 1 of the 7 patellar transplants had the appearance of hyaline cartilage.
Cultured autologous chondrocytes can be used to repair deep cartilage defects in the femorotibial articular surface of the knee joint.
Autologous chondrocyte transplantation. [N Engl J Med. 1995]
Chondrocyte transplantation--one answer to an old question. [N Engl J Med. 1994]
10.1056/NEJM199410063311401
Cartilage, Articular/cytology*
Cartilage, Articular/surgery*
Cell Transplantation*/methods
Joint Diseases/surgery
Knee Joint/surgery*
Patella/surgery
Surgical Flaps
Transplantation, Autologous
Transplantation - Genetic Alliance