A SINGLE-STAGE ARTHROSCOPIC TREATMENT OF ARTICULAR CARTILAGE DEFECTS: AUTOLOGOUS COLLAGEN-INDUCED CHONDROGENESIS. (ACIC: SHETTY-KIM TECHNIQUE) FIVE-YEAR RESULTS

Introduction

We describe five results of a novel single stage arthroscopic technique for the treatment of articular cartilage defects of the knee. This involves micro drilling and application of Atelo-collagen (Coltrix) and fibrin gel scaffold.

Materials and Method

The preclinical study involved two groups of rabbits treated with micro-drilling, and micro-drilling with Atelo-collagen and fibrin gel. New cartilage was subjected to staining with H&E for tissue morphology, toluidine blue (collagen) and safranin O (GAG), immunohistochemistry with antibodies for collagen type I and II, and scanning and transmission electron microscopy to analyse the microstructural morphologies. The micro-drilling with Atelo-collagen, fibrin gel scored better than the micro-drilling alone.

Patients (n=30) with symptomatic ICRS grade III/IV chondral defects (lesion size 2–8cm²) are recruited for this prospective study. The surgical procedure involved micro-drilling and application of Atelo–collagen and fibrin gel under CO₂ insufflation. Patients underwent morphological evaluation with MRI (T2*-mapping and d-GEMRIC scans). Clinical assessment was done with Lysholm, IKDC and KOOS scores. Radiological assessment was performed with MOCART score.

Results

At five years, Lysholm score was 74, compared to 49 pre-operatively (p<0.05). KOOS (symptomatic) improved to 92 from 62 (p<0.05). IKDC (subjective) went to 78 from 40 (p<0.05). The mean T2* relaxation-times for the repair tissue and native cartilage were 26 and 29.9 respectively. Average MOCART score for all lesions was 70.

Conclusion

This technique shows encouraging clinical results at five-year follow-up. The morphological MRI shows good cartilage defect filling and the biochemical MRI suggests hyaline like repair tissue.