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A Study to Compare Two Techniques for Articular Cartilage Repair:ACIC Vs. MCIC

Information source: Shetty-Kim Research Foundation
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Articular Cartilage Defect

Intervention: ACIC (Procedure); MCIC (Procedure); implant with a collagen + fibrin gel mixture (Device)

Phase: N/A

Status: Not yet recruiting

Sponsored by: Shetty-Kim Research Foundation

Official(s) and/or principal investigator(s):
Asode A Shetty, MD, PhD, MCh, FRCS, Principal Investigator, Affiliation: Canterbury Christ Church University

Overall contact:
Asode A Shetty, MD, PhD, MCh, FRCS, Phone: 01634 662813, Email: aashetty@hotmail.com

Summary

Study Title: A study to compare two articular cartilage repair techniques in the knee joint: Autologous Collagen Induced Chondrogenesis (ACIC) Vs. Mesenchymal Cell Induced Chondrogenesis (MCIC). Study hypothesis: We start with the hypothesis that both treatments are equally effective. Trial Design: This is a prospective study. The participating patients will be divided into two groups, each group receiving either one of the treatment modalities. This study will not be randomised or blinded. Both procedures will be done at the Spire Alexandra Hospital by Professor A. A Shetty, who is one half of the team that devised both techniques. Trial Participants: All participants will be from patients attending Professor Shetty's clinic at the Spire Alexandra Hospital. Planned Sample Size: 50 patients in each arm. Follow-up duration: The participating patients will be followed up at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 years following the surgery by visits to the clinic and assessed clinically. The surgical outcomes will be measured by by IKDC, KOOS and Lysholm scores; cartilage growth will be measured by the MOCART score. Planned Trial Period: Two to three years Primary Objective: To establish superiority, if any, of either procedure over the other. Primary Endpoint: At the end of the 2 year follow up for all participating patients.

Clinical Details

Official title: A Study to Compare Two Articular Cartilage Repair Techniques in the Knee Joint: Autologous Collagen Induced Chondrogenesis (ACIC) Vs. Mesenchymal Cell Induced Chondrogenesis (MCIC).

Study design: Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome:

Clinical outcome

Radiological outcome

Clinical outcome

Clinical outcome

Detailed description: BACKGROUND: Articular cartilage repair in the knee is aimed at young patients with area(s) of cartilage loss and no deformity of the knee. These patients aren't indicated for a knee replacement. Articular cartilage repair leads to improvement of symptoms of pain, locking and function. Traditionally, articular cartilage repair has always involved exposing the entire knee joint with an arthrotomy. This, though effective, would lead to a large scar, longer hospital stay, longer rehabilitation and its associated complications. Also, the use of Bone Marrow Aspirate Cells (BMAC) for the purpose of cartilage repair has long been debated with both sides having valid arguments and good surgical results. RATIONALE: Both procedures in this study are performed in one stage, arthroscopically and as day case procedures, which offers minimal scarring and quicker recovery. This automatically confers a significant advantage over the traditional surgical techniques. To correct the articular cartilage defect, the ACIC method requires autologous Atellocollagen (a protein based structure), while the MCIC method uses concentrated BMAC taken from the patient's iliac crest. Both procedures have shown encouraging results in terms of pain relief, cartilage growth and improved function. Since one technique utilises a protein based reagent and the other involves mesenchymal cells, this study aims to ascertain if either technique is superior to the other. STUDY DESIGN: This study aims to compare two techniques of articular cartilage repair in the knee, namely Autologous Collagen Induced Chondrogenesis (ACIC) and Mesenchymal Cell Induced Chondrogenesis (MCIC). The principal objective of is to ascertain and assess the superiority, if any, of either surgical technique over the other. The superiority will be assessed with by the certain scoring systems (IKDC, KOOS, Lysholm and MOCART) measured pre- and post-operatively. Depending on which procedure the patient chooses to have, they will be allotted to either the ACIC or the MCIC group. The patient is followed up in the clinic at the Spire Alexandra Hospital at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 years following the surgery and their progress is documented by questionnaires and clinical examination. MRI scans are done at one and two years to assess the extent of cartilage growth. SURGICAL TECHNIQUES Autologous Collagen Induced Chondrogenesis (ACIC): ACIC is a single stage arthroscopic procedure. It is done as a day case? procedure and the patient is admitted a few hours before the procedure. The anaesthetic method depends is the Anaesthesiologist's prerogative and depends on the patient's general health. Under sterile conditions in an operating theatre, the arthroscopic instruments are introduced inside the knee joint. As assessed previously by MRI scans, the area of cartilage defect is debrided by curettage, shaving and burring and then microfractured. The ACIC method utilises autologous Atellocollagen, a protein based structure, mixed with thrombin and fibrinogen to form a gel which coats the area with a cartilage defect. The entry ports are then closed and the knee is covered with a sterile dressing. The patient is transferred to the surgical recovery ward and, when medically stable, then transferred to their room on the ward. After discharge from the hospital, the patient is advised partial weight bearing on the operated leg for 6 weeks after the surgery. They also undergo 5 sessions of physiotherapy. Surgical clips and sutures are removed at 2 weeks following the surgery. Mesenchymal Cell Induced Chondrogenesis (MCIC): MCIC is a single stage arthroscopic procedure. It is done as a day case? procedure and the patient is admitted a few hours before the procedure. The anaesthetic method depends is the Anaesthesiologist's prerogative and depends on the patient's general health. Under sterile conditions in an operating theatre, the arthroscopic instruments are introduced inside the knee joint. As assessed previously by MRI scans, the area of cartilage defect is debrided by curettage, shaving and burring and then microfractured. The MCIC method involves aspiration of Bone Marrow Aspirate Cells (BMAC) from the patient's iliac crest (hip bone) and concentrating the cells by centrifugation in the operation theatre itself. The BMAC are then mixed with thrombin and fibrinogen to form a gel which coats the area with a cartilage defect. After discharge from the hospital, the patient is advised partial weight bearing on the operated leg for 6 weeks after the surgery. They also undergo 5 sessions of physiotherapy. Surgical clips and sutures are removed at 2 weeks following the surgery.

Eligibility

Minimum age: 18 Years. Maximum age: 65 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Participant is willing and able to give informed consent for participation in the

study.

- Male or Female, aged 18 years to 65 years.

- Diagnosed with articular cartilage defect in the knee (ICRS/Outerbridge grade III/IV

cartilage lesions as assessed on MRI scan).

- No other significant medical co-morbidities, as assessed by pre-operatively, that

could interfere with surgery results of trial eg. Hypertension, COPD etc.

- Participant has clinically acceptable laboratory and ECG tests at pre-assessment

clinic.

- Able (in the Investigators opinion) and willing to comply with all study

requirements.

- Up to 3 lesions of sizes 2-8 square cm.

Exclusion Criteria:

- Generalized and/or inflammatory arthritis

- Active joint inflammation

- More than 5 degrees of varus or valgus deformity

- Age below 18 and over 65 years

- More than 4 lesions

- Lesions more than 8 square cm.

- Significant co-morbidities or classified as ASA grade 3/4

Locations and Contacts

Asode A Shetty, MD, PhD, MCh, FRCS, Phone: 01634 662813, Email: aashetty@hotmail.com

Kent Knee Unit, Walderslade, Kent ME5 9PG, United Kingdom
Additional Information

Starting date: January 2014
Last updated: November 13, 2013

Page last updated: August 23, 2015

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