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Chatham, United Kingdom

Stelzeneder D.,Kent Knee Unit | Stelzeneder D.,Medical University of Vienna | Shetty A.A.,Kent Knee Unit | Shetty A.A.,Canterbury Christ Church University | And 6 more authors.
Skeletal Radiology | Year: 2013

Objective: A novel single-stage approach using arthroscopic microdrilling and atelocollagen/fibrin-gel application is employed for cartilage repair of the knee. The purpose of our study was to investigate the morphological and biochemical MRI outcome after this technique. Materials and methods: A retrospective case series of ten patients (mean age 45 years) with symptomatic chondral defects in the knee who were treated arthroscopically with microdrilling and atelocollagen application was analyzed. All defects were ICRS grade III or IV and the sizes were 2-8 cm2 intra-operatively. All patients underwent morphological MRI and T2-star mapping at 1.5 T at 1-year follow-up. The magnetic resonance observation of cartilage repair tissue (MOCART) score was assessed. T2*relaxation time values of repair tissue and a healthy native cartilage area was assessed by means of region of interest analysis on the T2*maps. Results: The mean MOCART score at 1-year follow-up was 71.7 ± 21.0 ranging from 25 to 95. The mean T2*relaxation times were 30.6 ± 11.3 ms and 28.8 ± 6.8 ms for the repair tissue and surrounding native cartilage, respectively. The T2*ratio between the repair tissue and native cartilage was 105 % ± 30 %, indicating repair tissue properties similar to native cartilage. Conclusions: An arthroscopic single-stage procedure using microdrilling in combination with atelocollagen gel and fibrin-glue can provide satisfactory MRI results at 1-year follow-up, with good cartilage defect filling. The T2*values in the repair tissue achieved similar values compared to normal hyaline cartilage. © 2013 ISS. Source


Autologous collagen-induced chondrogenesis is a novel, single-staged arthroscopic cartilage repair technique using microdrilling and atelocollagen or fibrin gel application under carbon dioxide insufflation. Atelocollagen is a highly purified type I collagen obtained following the treatment of skin dermis with pepsin and telopeptide removal, making it nonimmunogenic. In this procedure, atelocollagen mixed with fibrinogen and thrombin in a 2-way syringe can maintain the shape of the articular surface approximately 5 minutes after application due to the reaction between the thrombin and fibrinogen. Carbon dioxide insufflation facilitates the application of the gel under dry conditions. Ten patients (mean age, 38 years) with symptomatic chondral defects in the knee who were treated arthroscopically with microdrilling and atelocollagen application were retrospectively analyzed. All defects were International Cartilage Repair Society grade III or IV and were 2 to 8 cm(2) in size intraoperatively. For the clinical assessment, Lysholm score was assessed preoperatively and at 2-year follow-up. All patients underwent morphological magnetic resonance imaging at 1.5-Tesla at 1-year follow-up. Mean Magnetic Resonance Imaging Observation of Cartilage Repair Tissue score at 1-year follow-up was 70.4 ± 20.2 (range, 15-95). The Magnetic Resonance Imaging Observation of Cartilage Repair Tissue score for patellar lesions was similar to that of lesions in other locations: 73.3 ± 11.7 vs 68.1 ± 25.5, respectively. This technique had encouraging clinical results at 2-year follow-up. Morphological magnetic resonance imaging shows good cartilage defect filling, and the biochemical magnetic resonance imaging suggests hyaline-like repair tissue. Copyright 2013, SLACK Incorporated. Source


Shetty A.A.,Kent Knee Unit | Shetty A.A.,Canterbury Christ Church University | Kim S.J.,Kent Knee Unit | Kim S.J.,Catholic University of Korea | And 3 more authors.
Orthopedics | Year: 2013

Autologous collagen-induced chondrogenesis is a novel, single-staged arthroscopic cartilage repair technique using microdrilling and atelocollagen or fibrin gel application under carbon dioxide insufflation. Atelocollagen is a highly purified type I collagen obtained following the treatment of skin dermis with pepsin and telopeptide removal, making it nonimmunogenic. In this procedure, atelocollagen mixed with fibrinogen and thrombin in a 2-way syringe can maintain the shape of the articular surface approximately 5 minutes after application due to the reaction between the thrombin and fibrinogen. Carbon dioxide insufflation facilitates the application of the gel under dry conditions. Ten patients (mean age, 38 years) with symptomatic chondral defects in the knee who were treated arthroscopically with microdrilling and atelocollagen application were retrospectively analyzed. All defects were International Cartilage Repair Society grade III or IV and were 2 to 8 cm 2 in size intraoperatively. For the clinical assessment, Lysholm score was assessed preoperatively and at 2-year follow-up. All patients underwent morphological magnetic resonance imaging at 1.5-Tesla at 1-year follow-up. Mean Magnetic Resonance Imaging Observation of Cartilage Repair Tissue score at 1-year follow-up was 70.4±20.2 (range, 15-95). The Magnetic Resonance Imaging Observation of Cartilage Repair Tissue score for patellar lesions was similar to that of lesions in other locations: 73.3±11.7 vs 68.1±25.5, respectively. This technique had encouraging clinical results at 2-year follow-up. Morphological magnetic resonance imaging shows good cartilage defect filling, and the biochemical magnetic resonance imaging suggests hyaline-like repair tissue. Source


Shetty A.A.,Canterbury Christ Church University | Shetty A.A.,Kent Knee Unit | Kim S.J.,Kent Knee Unit | Kim S.J.,Catholic University of Korea | And 7 more authors.
Tissue Engineering and Regenerative Medicine | Year: 2014

We describe a single stage arthroscopic procedure for the treatment of articular cartilage defects in the knee. The novel procedure involves microfracture and application of bone marrow aspirate concentrate cells (BMAC) with hyaluronic acid and fibrin gel. The aim of the study was to evaluate the clinical and radiological outcomes at 2 years. A prospective study of 30 patients with symptomatic ICRS grade III/IV chondral defects, ranging from 2-9 cm2, who were assessed clinically and radiologically. The surgical procedure involved debridement of the lesion, microfracture and application of concentrated BMAC with HA and fibrin gel under CO2 insufflation. Patients underwent morphological MRI, quantitative T2-mapping and d-GEMRIC scan. Clinical assessment used the Lysholm, IKDC and KOOS scores. Radiological assessment used the MOCART score. At 2 year follow-up, Lysholm score was 80.1, as compared to 50.8 pre-operatively (p < 0.05). KOOS (symptomatic) was 92.1, as compared to 65.7 pre-operatively. IKDC (subjective) was 83, up from 39 preoperatively. The mean T2relaxation-times for the repair tissue and native cartilage were 29.1 and 29.9 respectively. Average MOCART score for all lesions was 72. Our technique shows encouraging clinical results at 2 year follow-up. Clinical outcome scores show significant benefit. The morphological MRI shows good cartilage defect filling and the biochemical MRI (T2-mapping) suggests hyaline like repair tissue. © 2014 The Korean Tissue Engineering and Regenerative Medicine Society and Springer Science+Business Media Dordrecht. Source

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