Articular Cartilage Lesion of the Femoral Condyle
Conditions
Keywords
Cartilage defects, Knee joint, Femoral Condyle
Brief summary
This is a prospective, phase III, multicenter, open label, randomised clinical trial of co.don chondrosphere®, a three-dimensional autologous chondrocyte transplantation product (ACT3D-CS)compared to the procedure of microfracture (MF)in the treatment of cartilage defects of knee joints. After screening visit patients were booked for arthroscopy and at that time they were randomised to either ACT3D-CS with co.don chondrosphere® (Group A) or to MF(Group B), a marrow-stimulating method based on the penetration of the subchondral bone plate at the bottom of the cartilage defect. At the time of arthroscopy Patients of group B had their procedure of MF (treatment surgery) and patients of group A had their cells harvested from healthy cartilage. The cells are cultivated for 8-10 weeks in vitro to develope 3-dimensional spheroids , that are transplanted in an open knee procedure (treatment surgery)into the defect. Patients subsequently followed the same rehabilitation program and had post-surgery visits. After the 12-month-visit a interim analyses will be performed and the 24-month-visit is defined as final assessment. Then patients have follow-up assessments up to 60 months post-treatment-surgery.
Detailed description
see above
Interventions
co.don chondrosphere® are spheroids in suspension, developed from autologous chondrocytes. The dose depends on the size of the defect, recommended dose is 10-70 spheroids/cm2 defect.
PROCEDUREMicrofracture
A procedure in which the subchondral bone is perforated to allow a bloodcloth to form new tissue.
Sponsors
co.don AG
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
1. Male or female patients, age: between 18 and 50 years 2. Defect: isolated ICRS grade III or IV single defect chondral lesions on femoral condyles 3. Defect size: 1 to \< 4 cm2 after debridement to healthy cartilage up to 6 mm in depth.Assessment with MRI at screening and per estimation during arthroscopy prior to randomization 4. Nearly intact chondral structure surrounding the defect as well as an intact corresponding joint area 5. Informed consent signed and dated by patient 6. Patient understands the strict rehabilitation protocol and follow-up programme and is willing to follow it 7. In case of pain, patient agrees to use only paracetamol mono- (max 4 g/day) or combination preparation and oral and/or topic NSAIDs during the trial and to discontinue the use of oral and/or topic NSAIDs and/or paracetamol combination preparation 1 week before each visit whereas the use of paracetamol monopreparation (max 4 g/day) is allowed. However, in the morning of the visit day, no pain medication is allowed. Other pain medications are allowed during surgical procedure and may be taken for a period not exceeding 4 weeks after surgery.
Exclusion criteria
1. Defects on both knees at the same time 2. Radiological signs of osteoarthritis 3. Osteochondritis dissecans (OCD) 4. Any signs of knee instability 5. Valgus or varus malalignment (more than 5° over the mechanical axis) 6. Clinically relevant second cartilage lesion on the same knee 7. More than 50 % resection of a meniscus in the affected knee or incomplete meniscal rim 8. Rheumatoid arthritis, parainfectious or infectious arthritis, and condition after these diseases 9. Pregnancy and planned pregnancy (no MRI possible) 10. Obesity (Body Mass Index \>30) 11. Uncontrolled diabetes mellitus 12. Serious illness 13. Poor general health as judged by physician 14. Participation in concurrent clinical trials or previous trials within 3 months of screening 15. Previous treatment with ACT in the affected knee 16. Microfracture performed less than 1 year before screening in the affected knee 17. Alcohol or drug (medication) abuse 18. Meniscal transplant in the affected knee 19. Meniscal suture (in the affected knee) three months prior to baseline 20. Mosaicplasty (Osteoarticular Transplant System, OATS) in the affected knee 21. Having received hyaluronic acid intra-articular injections in the affected knee within the last 3 months before baseline 22. Taking specific osteoarthritis drugs such as chondroïtin sulfate, diacerein, nglucosamine,piascledine, capsaicin within 2 weeks before baseline 23. Corticosteroid treatment by systemic or intraarticular route within the last month of baseline or intramuscular or oral corticosteroïds within the last 2 weeks before baseline 24. Chronic use of anticoagulants 25. Any concomitant painful or disabling disease of the spine, hips or lower limbs that would interfere with evaluation of the afflicted knee 26. Any clinically significant or symptomatic vascular or neurological disorder of the lower extremities 27. Any evidence of the following diseases in the affected knee: septic arthritis, inflammatory joint disease, recurrent episodes of pseudogout, Paget's disease of bone, ochronosis, acromegaly, haemochromatosis, Wilson's disease, primary osteochondromatosis, heritable disorders, collagen gene mutation 28. Current diagnosis of osteomyelitis, human immunodeficiency virus (HIV-1,-2) and/or hepatitis C virus (HCV) infection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change of overall KOOS | 24 months after the end of the respective treatment | Change of overall KOOS (Knee Injury and Osteoarthritis Outcome Score)from baseline (Day 0)to final assessment compared between ACT3D-CS (co.don chondrosphere) and MF (microfracture) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change of the 5 subscores of the KOOS | 12, 24, 36, 48, 60 months after the end of the respective treatment | Change of the 5 subscores of the KOOS (Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport/Rec), knee related Quality of life (QoL)) for both treatment groups compared between ACT3D-CS and MF |
| MOCART (MRI Score) | 12, 24, 36, 48 and 60 months after transplantation or microfracture | MOCART (MRI Score) 12, 24, 36, 48 and 60 months after transplantation or microfracture compared between ACT3D-CS and MF |
| Arthroscopy and biopsy | 24 months | Arthroscopy and biopsy at 24 months after transplantation/ microfracture, assessment of cartilage repair after ACT3D and microfracture to be compared between ACT3D-CS and MF |
| ICRS Visual Histological Assessment Score | 24 months after respective treatment | ICRS Visual Histological Assessment Score at final assessment (24 months) compared between ACT3D-CS and MF |
| Change of overall KOOS | 12, 36, 48, 60 months after the end of the respective treatment | Change of overall KOOS(Knee Injury and Osteoarthritis Outcome Score) from baseline (Day 0) to 12 months, 36, 48, 60 months after the end of the respective treatment,compared between ACT3D-CS and MF |
| Change of ICRS/IKDC | 12, 24, 36, 48 and 60 months after the end of the respective treatment | Change of ICRS/IKDC from baseline (Day 0) to 12, 24, 36, 48 and 60 months after the end of the respective treatment, compared between ACT3D-CS and MF |
| Change of modified Lysholm Score | 12, 24, 36, 48 and 60 months after the end of the respective treatment | Change of modified Lysholm Score from baseline (Day 0) to 12, 24, 36, 48 and 60 months after the end of the respective treatment compared between ACT3D-CS and MF |
| Days of absence from work (employment) and/or days of inability to follow usual activities | annual | Days of absence from work (employment) and/or days of inability to follow usual activities during the last year or since the last visit, respectively, and time point when patient was back to work and/or to follow usual activities |
| Safety Parameters | 3,12,24 months after respective treatment | Frequence and type of adverse Events Vital signs Physical examination Concomitant pain medication Laboratory parameters |
| Bern Score and additional histological assessment scores | 24 months after the respective treatment | Bern Score and additional histological assessment scores at final assessment (24 months) compared between ACT3D-CS and MF |
Countries
Germany, Poland
Outcome results
None listed