Summary

The LIPO-AMIC technique is feasible as treatment of knee cartilage defects, resulting in statistically significant progressive clinical, functional and pain improvements in all treated patients better than what reported for the AMIC standard technique, starting very early and maintaining the good clinical results more durably with stable results at mid-term follow-up.

Abstract

Background

Focal articular cartilage lesions are very common and often result in development of knee osteoarthritis (OA). Since available treatment modalities cannot guarantee long lasting cartilage regeneration, biologic augmentation procedures for the treatment of cartilage defects have been investigated and become of actual interest.

Objectives: To evaluate medium term outcomes of knee cartilage defects repair by autologous matrix-induced chondrogenesis combined with simultaneous use of autologous adipose tissue graft and ADSCs, defined as LIPO-AMIC technique.

Study Design & Methods: The LIPO-AMIC technique has been used for the treatment of ICRS degree III and IV focal cartilage defects in the knee (mean lesion size, 3,1 cm2). Eighteen patients have been prospectively evaluated during two and five years both clinically and by MRI evaluation. Mean age of the patients ( 5 females, 13 males) was 43,9 years (range 31-58). Defects were situated in the patella, in the femoral throclea, and femoral condyles. Patients were clinically evaluated by clinical assessment scores used preoperatively and at 6 and 12 months and at 2 and 5 years post-operatevely to compare treatment outcomes.

Results

Patients showed significant improvement of all scores starting at 6 months and further increased values were noted till the last follow-up at 60 months.
Mean subjective pre-operative IKDC score of 36,1 significantly increased to 86,4 at 24 months and to 87,2 at 60 months.
Mean pre-operative Lysholm Score of 44,4 reached 93,5 at 2 years and 93,5 at 5 years.
Mean total MOCART score showed a significative improvement from 69,1 points at 2 year follow-up to 81.9 points at last follow-up.
Complete filling of the defect at the level of the surrounding cartilage was found in 77.8 %.

Conclusions

Adipose tissue can represent ideal source of MSCs due to easiness of withdrawal and reported chondrogenic capacity.
The LIPO-AMIC technique is feasible as treatment of knee cartilage defects, resulting in statistically significant progressive clinical, functional and pain improvements in all treated patients better than what reported for the AMIC standard technique, starting very early and maintaining the good clinical results more durably with stable results at mid-term follow-up.