POSTER ABSTRACTS - ISAKOS

sutures, and potentially enhances cell
proliferation and maturation.
Large, full-thickness articular cartilage defects
greater than 2.5 to 3.0 cm2 pose a special problem
in young athletes. These lesions are often too
large for marrow stimulation procedures to be
predictably successful. Untreated, these lesions
often progress to posttraumatic arthritits and
disablility.
Autologous Chondrocyte Implantation (ACI) has
yielded encouraging results in greater thatn 88%
of the cases of deep chondral lesions.
Matrix/Membrane Autologous Chondrocyte
Implantation (MACI) is a new biotechnology
allowing the impregnation of autologous cultured
chondrocytes onto an autologous collagen matrix
which is templated to the chondral defect and
applied without sutures.
The procedure can be performed
arthroscopically.
Methods:
Forty-one patients were prospectively evaluated
for the effectiveness of the MACI procedure (35
knees, 6 ankles) on large, full-thickness (size 2-12
cm2) cartilage lesions (ages 16-52).
A second generation Membrane/Matrix
Autologous Chondrocyte Implantation (MACI)
technique was used after a previous arthroscopic
harvesting of articular chondrocytes (Verigen,
Leverkusen, GERMANY). The implant is fixed to
the chondral defect with a fibrin glue (Tissucol,
Baxter, SPAIN).
Patients were evaluated by clinical evaluation
using standardized scales, MRI,and several
second-look arthroscopies with cartilage biopsy
and histological study.
Results were also compared to 152 previously
performed ACIs.
Results:
Clinically, there were better than 86% good-toexcellent
results. The results compared favorably
to previously performed ACIs.
Histologically, a ''hyaline-like'' cartilage similar
to ACI was produced.
There was no case of delaminatrion of the MACI
series and one in the ACI series. No cases of
infection or phlebitis. Two (2) cases of stiffness
(treated by epidural and manipulation under
anesthesia at eight weeks).
Conclusion:
The MACI technique is a simple surgical
technique that produces a ''hyaline-like'' cartilage.
It reduces pain, improves activity level and quality
of life. The technique is substantially easier and
quicker than ACI; easier to template the lesion, no
periosteum needs to be harvested, no suturing of
the periosteal flap, and no injection of cells under
the flap into the defect.
MACI can be implanted by mini-arthrotomy or
arthroscopically and offers easier access to certain
sites where suturing of periosteal flaps are
difficult or even impossible.
E-poster #706
The Chondropenia Severity Score: A New
Clinical Tool for Articular Cartilage Defects
Jason Matthew Scopp, Salisbury, MD, USA,
Presenter
Bert R. Mandelbaum, Santa Monica, CA USA
Santa Monica Orthopaedic and Sports Medicine
Group, Santa Monica, CA, USA
Objective: We are Presenter a new classification
system to facilitate the assessment and
translation of knee arthroscopic findings. This
objective score serves as a comprehensive
method to develop a management algorithm with
prognostic indications. The purpose of this study
is twofold: First, we will introduce the
Chondropenia Severity Score (CSS). We define the
term chondropenia as cartilage loss over time.
The CSS is a simple arthroscopic score that
incorporates lesion size, depth, location and
meniscal integrity to form an objective description
of knee joint morphology. Second, we will
introduce the algorithm of the Chondropenic
Pathway. This pathway organizes patients with
articular cartilage defects (ACD's) into 10 separate
situations. Each situation has a specific treatment
plan.
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Methods: Data was prospectively collected from
175 consecutive knee arthroscopies performed by
the senior author over a 6 month period. The
arthroscopic findings and epidemiologic data
were recorded after each arthroscopy. The CSS is a
100 point scale. Points are lost for increasing
grade of articular cartilage lesion based upon the
International Cartilage Repair Society (ICRS)
articular cartilage injury classification. The
meniscus is also included in the CSS. Points are
lost based upon the percentage of meniscal
debridement. The patients were then stratified
into 1 of 10 situations as outlined in a
Chondropenic Pathway.
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The Chondropenic Pathway: