The purpose of this study is to compare two biologic methods for the treatment of articular cartilage defects in the knee. The first method, microfracture, is the standard of care and is routinely used to recruit cells from the subchondral bone marrow to the site of cartilage loss. The second method is the application of adipose-derived stem cells (ADSCs) to the defect site. In theory, ADSCs on a collagen scaffold should enable the delivery of more specific progenitor cells to the site of injury, resulting in better regeneration and integration of articular cartilage at the site of a defect as compared to the microfracture method.
Patients enrolled in the ADSC cohort will undergo the following procedures: arthroscopic resection of approximately 5cc of the infrapatellar fat pad using a motorized shaver (standard use in arthroscopy). Fat will be collected in a sterile Aquavage Collection System (AV1200, MD Resources, Livermore, CA) and kept sealed until processing. Fat will then immediately be processed in the Harvest Adiprep System to separate a population of ADSCs. This system concentrates an average of 5 x 105 cells/ml. All specimens will be processed using routine sterile procedures within the operating room; cells destined for implantation will not leave the operating room. Concurrently, patients will undergo arthroscopy and similar preparation of the chondral defect and removal of the calcified cartilage layer. However, no puncture of the subchondral bone will be performed. A layer of fibrin glue (Tisseel) will be placed at the base of the defect to seal off any bleeding from the subchondral plate followed by the application of the acellular dermal matrix (Allopatch HD, MTF Corporation, Edison, NJ, USA)and ADSCs. An additional layer of Tisseel will then be applied over the cells and matrix. No additional fixation will be applied. The matrix and cells will be recessed below the articular surface by an average of 1mm. They will then complete outcome questionnaires and additional MRI scans at 6, 12, and 24 months post-operatively.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
17
Patients will undergo arthroscopic resection of approximately 5cc of the infrapatellar fat pad, which will be collected for processing for a population of ADSCs. Patients will undergo arthroscopy and preparation of the chondral defect and removal of the calcified cartilage layer. Tisseel Fibrin glue will be placed at the base of the defect side, followed by the application of the acellular collagen dermal matrix, ADSCs, and an additional layer of fibrin glue.
Microfracture surgery is the standard of care for articular cartilage lesions. Patients will undergo arthroscopy with standard technique of microfracture preparation, including the creation of vertical, stable defect edges and removal of the calcified cartilage layer. A microfracture awl will then be used to perform the microfracture technique (6mm below the subchondral plate).
Stanford Medical Outpatient Center
Redwood City, California, United States
ACTIVE_NOT_RECRUITINGKerlan Jobe Orthopedic Institute
Santa Monica, California, United States
RECRUITINGUC Health Steadman Hawkins Clinic - Denver Inverness
Denver, Colorado, United States
RECRUITINGHealth Scores on the KOOS Questionnaire
The Knee Osteoarthritis Outcome Score (KOOS), a standard outcome questionnaire for the assessment of health-related quality of life, will be completed.
Time frame: Completed at baseline, 6 months, 12 months, and 24 months post-operatively.
Activity Level on the Tegner Activity Scale
The Tegner Activity scale, a standard outcome questionnaire for assessment of activity levels, will be completed.
Time frame: Completed at baseline, 6 months, 12 months, and 24 months post-operatively.
Cartilage Composition Assessment by MRI Scan
Magnetic resonance imaging scans consisting of routine clinical sequences and T2 and T1p quantitative maps will be conducted. T1p and T2 mapping will be used to assess regenerative cartilage composition compared to surrounding normal cartilage, surface integrity, average cartilage thickness, and the percentage to which the defect is filled.
Time frame: Assessed at baseline, 6 months, 12 months, and 24 months post-operatively.
Functionality Scores on the Lysholm Scale
The Lysholm Scale, a standard outcome questionnaire for assessment of knee functionality, will be completed.
Time frame: Completed at baseline, 6 months, 12 months, and 24 months post-operatively.
Pain Scores on the Visual Analog Scale (VAS)
The Visual Analog Scale, a standard outcome questionnaire for assessment of pain levels, will be completed.
Time frame: Completed at baseline, 6 months, 12 months, and 24 months post-operatively.
Health Scores on Veterans-Rand (VR-12) Survey
The Veterans-Rand survey, a standard outcome questionnaire for assessment of health and quality of life, will be completed.
Time frame: Completed at baseline, 6 months, 12 months, and 24 months post-operatively.
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