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Peer-reviewedCC BY-NC 4.0Cartilage

Autologous Chondrocyte Implantation With Knee Osteotomy in Middle-Aged Patients Demonstrates a Chondrogenic Transcriptomic Profile and Favorable Histological Repair

  • Tomoya Iseki1
  • Shintaro Onishi1
  • Ryo Kanto2
  • Yoshitaka Nakao1
  • Shunsuke Akai1
  • Akira Kawai1
  • Shinichi Yoshiya2
  • Shunsuke Takeuchi3
  • Toshiya Tachibana1
  • Hiroshi Nakayama1
  1. 1Department of Orthopedic Surgery, Hyogo Medical University, Nishinomiya, Japan
  2. 2Nishinomiya Kaisei Hospital, Nishinomiya, Japan
  3. 3Japan Tissue Engineering Co., Ltd., Gamagori, Aichi, Japan
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Abstract

Objective: The primary aim was to characterize cartilage repair following autologous chondrocyte implantation (ACI) with knee osteotomy in middle-aged patients, hypothesizing favorable histological repair and a chondrogenic transcriptomic profile. Secondary comparisons with isolated osteotomy were exploratory.

Design: This prospective case series with a nonrandomized comparison group included 12 patients aged 50–65 years with International Cartilage Repair Society (ICRS) grade 3–4 cartilage defects (>4 cm2) and varus malalignment. Six underwent two-stage ACI with osteotomy and six underwent osteotomy alone; allocation followed Japanese insurance indications for ACI. Patient-reported outcomes were assessed preoperatively and at 1 year. Both groups underwent second-look arthroscopy, ICRS II histological assessment, and RNA sequencing. Graft biochemical properties were compared between younger and older cohorts.

Results: The ACI group had higher macroscopic repair scores (10.3 ± 1.0 versus 6.0 ± 4.4; P = 0.04) and histological scores (median, 75 versus 50; P = 0.03). Lysholm scores improved in both groups (both P = 0.031); KOOS, IKDC, and VAS changes were not significant. No between-group differences in changes from baseline were significant for any patient-reported outcome. COL2A1, ACAN, and COMP expression was higher in the ACI group. Graft sGAG content and cell number did not differ significantly between age groups.

Conclusion: ACI with osteotomy showed favorable histological repair and a chondrogenic transcriptomic profile. The small sample, nonrandomized allocation, and short follow-up make between-group findings exploratory. Larger, longer-term studies are needed to establish clinical significance and durability.

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Cite

BibTeXRIS
BibTeX
@article{iseki2026autologous,
  title = {{Autologous Chondrocyte Implantation With Knee Osteotomy in Middle-Aged Patients Demonstrates a Chondrogenic Transcriptomic Profile and Favorable Histological Repair}},
  author = {Tomoya Iseki and Shintaro Onishi and Ryo Kanto and Yoshitaka Nakao and Shunsuke Akai and Akira Kawai and Shinichi Yoshiya and Shunsuke Takeuchi and Toshiya Tachibana and Hiroshi Nakayama},
  journal = {Cartilage},
  year = {2026},
  month = oct,
  doi = {10.1177/19476035261501621},
  url = {https://doi.org/10.1177/19476035261501621},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Autologous Chondrocyte Implantation With Knee Osteotomy in Middle-Aged Patients Demonstrates a Chondrogenic Transcriptomic Profile and Favorable Histological Repair
AU  - Tomoya Iseki
AU  - Shintaro Onishi
AU  - Ryo Kanto
AU  - Yoshitaka Nakao
AU  - Shunsuke Akai
AU  - Akira Kawai
AU  - Shinichi Yoshiya
AU  - Shunsuke Takeuchi
AU  - Toshiya Tachibana
AU  - Hiroshi Nakayama
PY  - 2026
DA  - 2026/10/27
JO  - Cartilage
DO  - 10.1177/19476035261501621
UR  - https://doi.org/10.1177/19476035261501621
AB  - Objective: The primary aim was to characterize cartilage repair following autologous chondrocyte implantation (ACI) with knee osteotomy in middle-aged patients, hypothesizing favorable histological repair and a chondrogenic transcriptomic profile. Secondary comparisons with isolated osteotomy were exploratory.  Design: This prospective case series with a nonrandomized comparison group included 12 patients aged 50–65 years with International Cartilage Repair Society (ICRS) grade 3–4 cartilage defects (>4 cm2) and varus malalignment. Six underwent two-stage ACI with osteotomy and six underwent osteotomy alone; allocation followed Japanese insurance indications for ACI. Patient-reported outcomes were assessed preoperatively and at 1 year. Both groups underwent second-look arthroscopy, ICRS II histological assessment, and RNA sequencing. Graft biochemical properties were compared between younger and older cohorts.  Results: The ACI group had higher macroscopic repair scores (10.3 ± 1.0 versus 6.0 ± 4.4; P = 0.04) and histological scores (median, 75 versus 50; P = 0.03). Lysholm scores improved in both groups (both P = 0.031); KOOS, IKDC, and VAS changes were not significant. No between-group differences in changes from baseline were significant for any patient-reported outcome. COL2A1, ACAN, and COMP expression was higher in the ACI group. Graft sGAG content and cell number did not differ significantly between age groups.  Conclusion: ACI with osteotomy showed favorable histological repair and a chondrogenic transcriptomic profile. The small sample, nonrandomized allocation, and short follow-up make between-group findings exploratory. Larger, longer-term studies are needed to establish clinical significance and durability.
SN  - 1947-6035
SN  - 1947-6043
ER  -