A 45-year-old patient, caucasian, affected by severe, painful and invalidating rizoarthrosis has been treated by implanting autologous chondrocytes, normally used for degenerative joint diseases of the knee and ankle

Carelli, Francesco

Magris, Cecilia

Sgherzi, Stefano

Sillani, Alessandro

English

PubMed

Francesco Carelli

Stefano Sgherzi

Alessandro Sillani

Cecilia Magris

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Effective implantation of autologous chondrocytes in a patient suffering from a painful and invalidating rizoarthrosis: a case report

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Case report
Open Access
Effective implantation of autologous chondrocytes in a patient
suffering from a painful and invalidating rizoarthrosis: a case report
Francesco Carelli*, Stefano Sgherzi, Alessandro Sillani and Cecilia Magris
Address: School of Medicine, University of Milan, Via Festa del Perdono 7, 20122 Milano, Italy
Email: FC* - carfra@tin.it; SS - Stefano.sgherzi@gmail.com; AS - alessandro.sillani@gmail.com; CM - cecylia_m@hotmail.com
*Corresponding author
Received: 20 May 2009 Accepted: 16 July 2009 Published: 2009
Cases Journal 2009, 2:7886 doi: 10.4076/1757-1626-2-7886
This article is available from: http://casesjournal.com/casesjournal/article/view/7886
© 2009 Carelli et al.; licensee Cases Network Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
A 45-year-old patient, caucasian, affected by severe, painful and invalidating rizoarthrosis has been
treated by implanting autologous chondrocytes, normally used for degenerative joint diseases of the
knee and ankle.
Case presentation
The patient is a 45-year-old Caucasian woman known
to suffer from rizoarthrosis, who has already under-
gone antidolorific and anti-inflammatory therapy (oral
and systemic), as well as physiotherapy and other
treatment such as ionophoresis, ultrasound and elec-
trotherapy. She comes to our surgery and complains
that the pain in her right hand is becoming more and
more severe, with loss of the joint function, which is
not only impeding her work, but also restricts her daily
activities.
Therefore we had to think about a more effective therapy.
She has been finally treated by implanting autologous
chondrocytes, normally used for degenerative joint
diseases of the knee and ankle.
Because of the young age of the patient we were doubtful
about using the classical procedures (trapeziectomy,
prosthesis, etc.), preferring to apply a less invasive
technique which could guarantee good movement and
alleviation of the pain in the case of success, but without
compromising the possible need to resort to conventional
therapies in the event of failure.
We therefore read up widely on the different therapeutic
possibilities for rizoarthrosis and were impressed by the
encouraging achievements reported by the literature of a
therapy which is still in the experimentation phase and
involves the use of autologous chondrocytes. In our
opinion this could be the most appropriate for our patient.
We informed her about this new possibility, and it was
agreed thatwe shouldundertake this new typeof treatment.
Our patient was then examined in the outpatients’
department of microsurgery of the hand at the Gaetano
Pini Hospital in Milan, and the orthopaedic surgeon
confirmed that she would be an ideal candidate to take
part in the clinical trial.
She therefore joined the first clinical trial, the goal of
which was to assess the application of the technique of
autologous chondrocytes transplant in small joints at the
Gaetano Pini Hospital in Milan.
The treatment was carried out in March 2008, and it seems
to have been successful: for the moment the patient is
enjoying good health.
Page 1 of 3
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The joint cartilage covers the articular bones in order to
protect them from friction and allow them to move.
The implant of autologous chondrocytes (Tissue Engineer-
ing) becomes a valid alternative to the classical treatments
employed in cases of joint cartilage damage in patients
destined for invalidity or for prosthetic replacement of the
damaged bones [1-3].
Because of its particular architecture (few cells situated far
apart, surrounded by a dense matrix, and absence of
vessels and nerves), the hyaline cartilage is not able to
regenerate itself.
Followingdamage, it can sometimes start a reparativeprocess,
which leads to the formation of fibrous cartilage (collagen
type I) with characteristics of resistance and deformability
very different from those presented by the original hyaline
cartilage (collagen type II). Consequently, it will originate
a degenerative arthrosic pathology accompanied by the
onset of chronic pain and functional limitation [4,5].
The symptoms are mostly movement difficulties due to
pain, swelling, hemartrosis and at times joint block.
Surgical treatment is recommended above all in those
cases in which pain is the predominant symptom and
persists in spite of the use of antidolorific therapy.
The Mosaic Graft and the Microfracture are surgical
techniques which present the disadvantage of originating
fibrous cartilage, which is not as resistant and functional as
the hyaline cartilage, and can be performed in arthroscopy
only in the case of small lesions (<3 cm²).
The implant of autologous chondrocytes has shown that
it can induce the regeneration of hyaline cartilage, even if
the joint lesions are deep [6,7]. In fact its trophism does
not depend on blood flow, but is guaranteed directly by
the synovial liquid. Nor is innervation necessary.
A small fragment of healthy cartilage tissue is taken by
means of arthroscopy from an area not subjected to load
and is sent to a laboratory for replication of the cartilage
cells. There it undergoes enzymatic digestion, followed
by isolation and cell culture. After nearly a month of
growing, the chondrocytes can be transplanted [8-10].
The cells, adhering to a collagen membrane, are implanted
into the patient using a fibrin adhesive, absorbable sutures
or resorbable pins.
During the following weeks and months the membrane
will dissolve and the chondrocytes produce the matrix for
the cartilage’s regeneration.
As with other surgical procedures, the capital moment is
the post-surgery rehabilitation of the patient. The stay in
hospital will be around 5-6 days. The day after surgery the
patient starts the programme of functional re-education
with passive mobility of the joint. Active exercises start
after 25-30 days, with progressive loading beginning after
30 days and completed after 3 months with proprioceptive
and functional re-education exercises.
Low levels of exercise can be started after 5months and can
then be increased after 1 year.
Although the new cartilage develops after a few weeks, it is
better to avoid prolonged effort for a period of at least
4-6 months in order to allow perfect maturation of the
new tissue.
The implant technique of autologous chondrocytes was
developed in Sweden by Brittberg and colleagues and has
already been used in many European and non-European
countries for about ten years. It achieves a high percentage
of recovery in joints such as the knee or ankle.
Recently this technique has been employed in the
treatment of rizoarthrosis and articular damage to the
hand and wrist, with more benefits in comparison to
classical techniques.
Even if arthroplasty of the trapezium-metacarpal articula-
tion with trapeziectomy achieves good results in terms of
pain relief and mobility, it involves a loss of strength due
to trapezium removal, and after some years this could lead
to instability of the index finger.
Arthrodesis resolves the pain and maintains the strength,
but induces a limitation of mobility and can involve
intercarpal arthrosic degeneration.
The use of a prosthesis has shown good results, but these
are not always long-lasting.
The risks that could occur in the implantation of
autologous chondrocytes are the same as with all surgical
interventions (septic, thromboembolic and anestesiolo-
gic complications etc.). There is a non-predictable risk,
including that due to cartilage manipulation, allergic
reactions to the buffer solution employed in the conserva-
tion of the product, the risk of loss of the initial benefits
after a time, or the risk that the intervention turns out to be
unsuccessful.
In the event of failure it is still possible to resort to the
classical techniques, since the implantation of autologous
chondrocytes does not rule out the possibility of
subsequent traditional treatment.
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Cases Journal 2009, 2:7886 http://casesjournal.com/casesjournal/article/view/7886
Consent
Written informed consent was obtained from the patient
for publication of this case report and accompanying
images. A copy of the written consent is available for
review by the Editor-in-Chief of this journal.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
As indicated with the names, the different authors have
a different position and role in the practice and the same
was for elaborating this paper. FC introduced the case, had
contacts with patient and took an overall control; SS and
AS developed the paper and CM was in charge for a good
translation of all. All authors read and approved the final
manuscript.
References
1. Griffith LG, Naughton G: Tissue engineering-current challenges
and expanding opportunities. Science 2002, 295:1009-1014.
2. Vacanti CA, Vacanti JP: The science of tissue engineering. Orthop
Clin North AM 2000, 31:351-356.
3. Sittinger M, Bujia J, Rotter N, Reitzel D, Minuth WW, Burmester GR:
Tissue engineering and autologous transplant formation:
pratical approaches with resorbable biomaterials and new
cell culture techniques. Biomaterials 1996, 17:237-242.
4. Miller EJ: A review of biochemical studies on the genetically
distinct collagens of skeletal system. Clin Orthop 1973, 92:
260-280.
5. Shapiro F, Koide S, Glimcher MJ: Cell origin and differentiation in
the repair of full-tickness defects of articular cartilage. J Bone
Joint Surg 1993, 75/A:532-553.
6. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L:
Treatment of deep cartilage defects in the knee with
autologous chondrocyte transplantation. New Engl J Med
1994, 331:889-895.
7. Outerbridge RE: The etiology of chondromalacia patellae.
J Bone Joint Surg 1961, 43B:752-757.
8. Noyes FR, Stabler CL: A system for grading articular cartilage
lesion at arthroscopy. AM J Sports Med 1989, 17:505-513.
9. Tegner Y, Lysholm J: Rating system in the evaluation of knee
ligament injuries. Clin Orthop Relate Res 1985, 198:43-49.
10. Sgaglione NA, Del Pizzo W, Fox JM, Friedman MJ: Critical analysis
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660-667.
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Effective implantation of autologous chondrocytes in a patient suffering from a painful and invalidating rizoarthrosis: a case report

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