Matrix assisted autologous chondrocyte transplantation: long term results and prognostic factors

Objectives: Aim of this study is to evaluate the long term results of matrix-assisted autologous chondrocyte transplantation on a biodegradable hyaluronian-based biocompatible scaffold (Hyalograft C). Methods: 60 patients (41 men, 19 women; mean age: 29.8 yy, mean lesion size: 2.5 cm2) affected by knee chondral lesions, were enrolled and treated by the implantation of a hyaluronic acid based bioengineered tissue. Lesions were located at medial femoral condyle (34), lateral femoral condyle (19), throclea (7) and tibial plateau (2). The surgical technique consisted in two arthroscopic steps and all the patients were evaluated prospectively yearly for up to 10 years of follow-up. Evaluation tools employed were: IKDC, EQ-VAS, and Tegner scores. Complications, failures, and patient satisfaction were also documented. Results: Significant increases in all clinical scores were registered over time after chondrocyte implantation. IKDC-subjective score raised from 39.0 to 75.9 after 24 months (p\0.05) and results remained stable up to the final evaluation at 10 years’ follow-up (71.1; p\0.05). The same trend was registered in EQ-VAS which passed from 60/100 pre-operatively to 81/100 at 2 years’ follow up and finally reached 70/100 at 10 years. Tegner score also increased from a basal value of 2–5 after 2 years of follow-up, and it remained stable over time, even if the sport activity level registered at the last evaluation was significantly lower than pre-injury (4.5 vs 7; p\0.05). No major adverse events were reported. Conclusions: Autologous chondrocyte transplantation on a hyaluronan based matrix is a safe and effective technique for the treatment of medium size chondral defects. Clinical outcome is satisfying and stable at long term-evaluation and the entirely arthroscopic approach is able to minimize the surgical stress for the patient.