Cell Carriers as the Next Generation of Cell Therapy for Cartilage Repair

A Review of the Matrix-Induced Autologous Chondrocyte Implantation Procedure

Brittberg, Mats MD, PhD

From the Department of Orthopaedics, Kungsbacka Hospital, Kungsbacka, Sweden

^*Address correspondence to Mats Brittberg, MD, PhD, Kungsbacka Hospital Cartilage Research Unit, University of Gothenburg, Department of Orthopaedics, Kungsbacka Hospital, Kungsbacka, Sweden S-434 80 (e-mail: [email protected]).

One or more of the authors has declared a potential conflict of interest: Genzyme Biosurgery provided support to medical writers for assistance with article preparation.

The author did not directly receive any direct financial support for the development and preparation of this article.

American Journal of Sports Medicine 38(6):p 1259-1271, June 2010. | DOI: 10.1177/0363546509346395

Background:

Since the first patient was implanted with autologous cultured chondrocytes more than 20 years ago, new variations of cell therapies for cartilage repair have appeared. Autologous chondrocyte implantation, a first-generation cell therapy, uses suspended autologous cultured chondrocytes in combination with a periosteal patch. Collagen-covered autologous cultured chondrocyte implantation, a second-generation cell therapy, uses suspended cultured chondrocytes with a collagen type I/III membrane. Today's demand for transarthroscopic procedures has resulted in the development of third-generation cell therapies that deliver autologous cultured chondrocytes using cell carriers or cell-seeded scaffolds.

Purpose:

To review the current evidence of the matrix-induced autologous chondrocyte implantation procedure, the most widely used carrier system to date. Also discussed are the characteristics of type I/III collagen membranes, behavior of cells associated with the membrane, surgical technique, rehabilitation, clinical outcomes, and quality of repair tissue.

Study Design:

Systematic review.

Methods:

Relevant publications were identified by searching Medline from its inception (1949) to December 2007; peer-reviewed publications of preclinical and clinical cell behavior, manufacturing process, surgical technique, and rehabilitation protocols were identified. Preclinical and clinical studies were included if they contained primary data and used a type I/III collagen membrane.

Results:

Data from these studies demonstrate that patients treated with matrix-induced autologous chondrocyte implantation have an overall improvement in clinical outcomes. Reduced visual analog scale pain levels (range, 1.7–5.32 points) and improvements in the modified Cincinnati (range, 3.8–34.2 points), Lysholm-Gillquist (range, 23.09–47.6 points), Tegner-Lysholm (range, 1.39–3.9 points), and International Knee Documentation Classification scale (P <.05) were observed. Patients had good-quality (hyaline-like) repair tissue as assessed by arthroscopic evaluation (including International Cartilage Repair Society score), magnetic resonance imaging, and histology, as well as a low incidence of postoperative complications.

Conclusion:

The findings suggest that matrix-induced autologous chondrocyte implantation is a promising third-generation cell therapy for the repair of symptomatic, full-thickness articular cartilage defects.