Investigating the biomechanical and functional outcomes of autologous chondrocyte implantation: A multi-centre study

Knee injuries are common. Sometimes, knee injuries can damage the lining of the knee’s bones, called cartilage. Cartilage injuries cause pain and limit movement, making activities like walking, playing sports, and working difficult.

Cartilage cannot repair itself well, so surgery is sometimes needed to repair the injury. People who have cartilage repair surgery want to return to normal activities after their operation, like working and playing sports. Doctors and scientists know that cartilage repair surgery can reduce pain, but they do not fully understand how it affects movement.

This research will help us understand if knee function gets better after a certain type of cartilage repair surgery called autologous chondrocyte implantation (ACI). The results will help doctors and patients understand what to expect after ACI. It could also uncover common weaknesses in the knee after surgery that could be avoided in future by updating the current physiotherapy programmes for ACI patients.

The main aims and objectives of the research study.

The main aim of this study is to measure changes to knee movement and walking ability 6 months after ACI surgery. The objective is to understand how knee function changes in the early months following ACI surgery.

How this research is going to help address MSK health.

This project will improve our understanding of how ACI, a cartilage repair surgery, impacts knee function and mobility (biomechanics).

Understanding the impact of ACI on biomechanics is vital for patient satisfaction and long-term treatment success.

If this study finds common weaknesses in the knee after surgery, it will be important to share this with future patients. This will help them decide whether or not to have the surgery.  It will also help future patients set realistic expectations for their surgery.

This research will also be valuable to healthcare professionals. Firstly, it could improve the way they select and prepare patients for surgery. But most importantly, it could help them plan effective physiotherapy programmes for ACI patients, to make sure that their patients get the most out of their surgery.

Normal knee function is important to enable patients to do all the things they used to be able to do before their injury, as well as return to an independent and mobile lifestyle. Because of this, this research may have indirect benefits too. Patients with better function after surgery are less likely to need follow-on surgery, and are more likely to be able to continue working. They may also be less likely to develop arthritis and long-term illnesses that are linked to inactive lifestyles.

The main research methods, or datasets being used.

Adult patients who are waiting to have ACI surgery at one of 7 hospitals in England will be invited to take part in this study. Patients who decide to take part will be invited to two appointments at their own hospital, where tests of their knee function and walking ability will take place. The first test will measure how much the individual can bend and straighten both knees. The second test will involve walking over a platform to record detailed biomechanical information on their walking pattern. Participants will also be asked to stand on the platform to assess their balance. Finally, participants at the main research site in Manchester will be asked to walk on a treadmill to record more information about the knee’s movement.

The first research appointment will take place before the participant’s operation, and the second and final appointment will take place 6-months after surgery. The results from both appointments will be compared to see how function and walking ability has changed.

At the same time, the researchers will also run another study with healthy adults with no knee injuries. The same tests will be carried out. The results of this study will help us understand if the people in the patient group have similar results to the people without knee injuries after their surgery.

Research results generated.

Since this study started in January 2024, the researchers have been getting approvals from all the hospitals to start recruiting participants. They are now open to recruitment at 5 of the 7 hospitals. So far, 5 patients have been recruited into the study.

The project has been given approval by the University of Manchester to start the second study with adults with no knee injuries. So far, they have recruited 9 people into this study.

They hope to be able to share early findings from this research with the participants and general public once the first patients have returned for their 6-month post-surgery visit.

Next steps of this research project.

The next step is to continue recruiting participants into both studies, and carry on collecting data. They are looking to recruit 47 participants into each study.

In January 2024 the project will run an online Public Engagement event to share our early findings with the participants and members of the public.

Towards the end of the year, they will also start applying for more funding to expand this project. One thing they would like to do is see how ACI impacts knee function beyond 6 months.

Publications and presentations related to this fellowship.

Tawy G., Timme, B., McNicholas, M., Biant., L. Gait characteristics of patients with symptomatic cartilage lesions of the knee.Journal of Cartilage & Joint Preservation (2024) Available online: https://doi.org/10.1016/j.jcjp.2024.100175

Smith, L., Jakubiec, A., Biant, L., Tawy, G (2023). The biomechanical outcomes of Autologous Chondrocyte Implantation for articular cartilage defects of the knee: A systematic review. Knee Oct: 44:31-42. DOI: 10.1016/j.knee.2023.07.004

Awards or recognition received related to this project.

Gwenllian Tawy  received recognition for this work at a Fellowship Inaugural Lecture on 12^th June 2024 at the University of Manchester.

Impact of this Orthopaedic Research UK fellowship on your research and career

“As a new Fellow, I am now recognised as an independent researcher at my university. This has led to more teaching opportunities, and will hopefully lead to a permanent lectureship. Becoming a lecturer is my next career goal.”

Engagement with research users, special interest groups and the general public to inform them about the research.

The researchers have been regularly updating the public about this research on our website (https://personalpages.manchester.ac.uk/staff/gwenllian.tawy/) and LinkedIn accounts. The study’s Patient Contributor, Tamsen Lesko, works to make sure that everything shared with the public is written for patients and the general public.

Gwenllian Tawy  has been invited to present this research to local healthcare professionals and at national conferences.

Influence of research project on policy, practice or patients.

The results from this research may result in changes to practice, particularly to physiotherapy protocols after ACI surgery. This could lead to improvements in knee function in patients who have had ACI.

Researcher: Gwenllian Tawy

Supervisor(s): Leela Biant

University or Trust: University of Manchester

Award stream: BASK/ORUK Research Fellowship 2023

Award duration: 24 months

Amount rewarded: £112,838

Other funders: N/A

Collaborations/ partners: Professor Leela Biant & Mr Michael McNicholas (Manchester University NHS Foundation Trust); Mr Martyn Snow (Royal Orthopaedic Hospital NHS Trust); Mr Ram Venkatesh (Leeds Teaching Hospitals NHS Trust); Mr Chethan Jayadev (Royal National Orthopaedic Hospital NHS Trust); Mr Gorav Datta & Mr Amir Qureshi (University Hospital Southampton NHS Trust); Mr Wasim Khan (Cambridge University Hospitals NHS Foundation Trust); Mr Varun Dewan (The Royal Wolverhampton NHS Trust).