Background Full-thickness defects of articular cartilage inthe knee have a poor capacity for repair. They may progressto osteoarthritis and require total knee replacement. We performedautologous chondrocyte transplantation in 23 people with deepcartilage defects in the knee.
Methods The patients ranged in age from 14 to 48 years and hadfull-thickness cartilage defects that ranged in size from 1.6to 6.5 cm2. Healthy chondrocytes obtained from an uninvolvedarea of the injured knee during arthroscopy were isolated andcultured in the laboratory for 14 to 21 days. The cultured chondrocyteswere then injected into the area of the defect. The defect wascovered with a sutured periosteal flap taken from the proximalmedial tibia. Evaluation included clinical examination accordingto explicit criteria and arthroscopic examination with a biopsyof the transplantation site.
Results Patients were followed for 16 to 66 months (mean, 39).Initially, the transplants eliminated knee locking and reducedpain and swelling in all patients. After three months, arthroscopyshowed that the transplants were level with the surroundingtissue and spongy when probed, with visible borders. A secondarthroscopic examination showed that in many instances the transplantshad the same macroscopic appearance as they had earlier butwere firmer when probed and similar in appearance to the surroundingcartilage. Two years after transplantation, 14 of the 16 patientswith femoral condylar transplants had good-to-excellent results.Two patients required a second operation because of severe centralwear in the transplants, with locking and pain. A mean of 36months after transplantation, the results were excellent orgood in two of the seven patients with patellar transplants,fair in three, and poor in two; two patients required a secondoperation because of severe chondromalacia. Biopsies showedthat 11 of the 15 femoral transplants and 1 of the 7 patellartransplants had the appearance of hyaline cartilage.
Conclusions Cultured autologous chondrocytes can be used torepair deep cartilage defects in the femorotibial articularsurface of the knee joint.
Source Information
From the Departments of Orthopedic Surgery (M.B., A.N., L.P.), Clinical Chemistry (A.L.), and Internal Medicine (C.O., O.I.), Research Center for Endocrinology and Metabolism, University of Goteborg, Sahlgrenska University Hospital, Goteborg, Sweden. Presented at the first meeting of the Osteoarthritis Research Society, Paris, Dec.10-12, 1992.
Address reprint requests to Dr. Lindahl at the Research Center for Endocrinology and Metabolism, Department of Clinical Chemistry, Sahlgrenska University Hospital, S-413 45 Goteborg, Sweden.
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