Articular Cartilage Lesion of the Femoral Condyle
Conditions
Keywords
Cartilage, Articular, Femoral, Knee, Chondrocytes, Adipose tissue-derived mesenchymal stem cells
Brief summary
The objective of our study is to compare the safety and effectiveness of the use of autologous cultured adipose tissue-derived stem cells versus cultured autologous chondrocytes for the treatment of chondral knee lesions.
Detailed description
Chondral knee lesions are frequent and produce important functional limitations and arthrosis development. Arthrosis is one of the most important causes of disability and its treatment with prosthetic surgery is associated with a high cost, and is not free of other complications. Several studies of cell therapy with autologous chondrocytes have shown efficacy in the treatment of this type of lesions, and currently is a common technique for the treatment of focal lesions of articular cartilage. Autologous chondrocyte transplant is associated with morbidity of the cartilage sample removal, which needs intra-articular surgery, and the limited tissue sample for culture. Adipose tissue-derived mesenchymal stem cells (ASC) have demonstrated chondrocytic differentiation and have been used in animal models for articular cartilage repair. Adipose tissue yields more ASC than chondrocytes are obtained from cartilage, and liposuction is simple and with less adverse events than arthroscopy. It is worth mentioned that culture conditions are less stringent for ASC than for chondrocytes, in terms of number of passages to obtain the amount of cells needed for implantation. We propose a randomized clinical trial, in which we compare the surgical implantation of either autologous chondrocytes or autologous ASC to treat chondral knee lesions.
Interventions
OTHERImplantation of autologous cells
Implantation of autologous ASC or chondrocytes, 1 million per cm² lesion, covered by autologous periosteal membrane
Sponsors
Fundacion para la Investigacion Biomedica del Hospital Universitario la Paz
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* Symptomatic focal articular cartilage lesion on the medial femoral condyle * Lesion on femoral condyle between 1 and 5 cm² * ICRS Grade III/IV * Stable knee * Signed patient informed consent
Exclusion criteria
* Clinically relevant member malalignment (\> 5 degrees) * Non stable knee * Inflammatory joint disease * Knee surgery in the last year (transplant, suture or resection of the meniscus, mosaicplasty, microfracture) * Participation in concurrent trials or in the previous 3 months * Subjects with hepatitis, HIV or syphilis * Malignancy in the previous 5 years * Alcohol and/or drug abuse * Poor general health as judged by Investigator * Clinically relevant second cartilage lesion on the patella * Patellofemoral cartilage lesion * Known allergy to gentamicin or penicillins (or presence of multiple severe allergies) * Having received hyaluronic acid intra-articular injections in the affected knee within the last 6 months of baseline * Taking specific OA drugs such as chondroitin sulfate, diacerein, n-glucosamine, piascledine, capsaicin within 2 weeks of the baseline visit * Corticosteroid treatment by systemic or intra-articular route within the last month of baseline or intramuscular or oral corticosteroids within the last 2 weeks of baseline * Chronic use of anticoagulants * Uncontrolled diabetes * Any concomitant painful or disabling disease of the spine,hips or lower limbs that would interfere with evaluation of the afflicted knee * Any clinically significant or symptomatic vascular or neurologic disorder of the lower extremities * Liver enzymes (SGOT, SGPT, Alkaline Phosphatase) of more then two times the upper limit of normal or any other result that is clinically important according to the Investigator * CRP \> 10 mg/l
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Hyaline cartilage production for chondral knee lesions repair | 18 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy: Functional evolution | 18 months | Changes in Western Ontario-McMaster Osteoarthritis Score(WOMAC) over 18 months |
| Efficacy: Histological evaluation | 18 months | Hyaline cartilage production by histological methods at 18 months |
| Efficacy: Clinical evolution | 18 months | Changes in Clinical tests and SF-12 Health Survey over 18 months |
| Safety: Adverse events | 18 months | Sistemic and local AEs especially attributable to implanted cells |
| Safety: Acute inflammatory events | 18 months | Increase of pain of at least 30 mm on a 100 mm visual analog scale (VAS) along with self-reported swelling within 3 days post-cell application |
| Efficacy: Radiological evaluation | 18 months | MRI at 18 months |
Countries
Spain
Contacts
Primary ContactAlonso C. Moreno Garcia, MD
Backup ContactFernando de Miguel
Outcome results
None listed