scholarly journals A Comparison of 2-Year Outcomes in Patients Undergoing Tibiofemoral or Patellofemoral Matrix-Induced Autologous Chondrocyte Implantation

2017 ◽  
Vol 45 (14) ◽  
pp. 3243-3253 ◽  
Author(s):  
Jay R. Ebert ◽  
Adrian Schneider ◽  
Michael Fallon ◽  
David J. Wood ◽  
Gregory C. Janes
Keyword(s):  
Quality Of Life ◽  
Daily Living ◽  
Autologous Chondrocyte Implantation ◽  
Composite Score ◽  
Significant Group ◽  
Chondrocyte Implantation ◽  
Femoral Condyles ◽  
Over Time ◽  
Autologous Chondrocyte

Background: Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging clinical results in the treatment of knee chondral defects. However, earlier studies suggested that chondrocyte implantation in the patellofemoral (PF) joint was less effective than in the tibiofemoral (TF) joint. Purpose: To compare the radiological and clinical outcomes of those undergoing MACI to either the femoral condyles or PF joint. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 194 patients were included in this analysis, including 127 undergoing MACI to the medial (n = 94) and lateral (n = 33) femoral condyle, as well as 67 to the patella (n = 35) or trochlea (n = 32). All patients were evaluated clinically (Knee injury and Osteoarthritis Outcome Score [KOOS], visual analog scale, Short Form–36) before surgery and at 3, 12, and 24 months after surgery, while magnetic resonance imaging (MRI) was undertaken at 3, 12, and 24 months, with the MOCART (magnetic resonance observation of cartilage repair tissue) scoring system employed to evaluate the quality and quantity of repair tissue, as well as an MRI composite score. Patient satisfaction was evaluated. Results: No significant group differences ( P > .05) were seen in demographics, defect size, prior injury, or surgical history, while the majority of clinical scores were similar preoperatively. All clinical scores significantly improved over time ( P < .05), with a significant group effect observed for KOOS activities of daily living ( P = .008), quality of life ( P = .008), and sport ( P = .017), reflecting better postoperative scores in the TF group. While the PF group had significantly lower values at baseline for the KOOS activities of daily living and quality of life subscales, it actually displayed a similar net improvement over time compared with the TF group. At 24 months, 93.7% (n = 119) and 91.0% (n = 61) of patients were satisfied with the ability of MACI to relieve their knee pain, 74.0% (n = 94) and 65.7% (n = 44) with their ability to participate in sport, and 90.5% (n = 115) and 83.6% (n = 56) satisfied overall, in the TF and PF groups, respectively. MRI evaluation via the MOCART score revealed a significant time effect ( P < .05) for the MRI composite score and graft infill over the 24-month period. While subchondral lamina scored significantly better ( P = .002) in the TF group, subchondral bone scored significantly worse ( P < .001). At 24 months, the overall MRI composite score was classified as good/excellent in 98 TF patients (77%) and 54 PF patients (81%). Conclusion: MACI in the PF joint with concurrent correction of PF maltracking if required leads to similar clinical and radiological outcomes compared with MACI on the femoral condyles.

scholarly journals A Prospective, Randomized, Open-Label, Multicenter, Phase III Noninferiority Trial to Compare the Clinical Efficacy of Matrix-Associated Autologous Chondrocyte Implantation With Spheroid Technology Versus Arthroscopic Microfracture for Cartilage Defects of the Knee

2019 ◽  
Vol 7 (7) ◽  
pp. 232596711985444 ◽  
Author(s):  
Philipp Niemeyer ◽  
Volker Laute ◽  
Wolfgang Zinser ◽  
Christoph Becher ◽  
Thomas Kolombe ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Cartilage Repair ◽  
Daily Living ◽  
Autologous Chondrocyte Implantation ◽  
Statistical Hypothesis ◽  
Cartilage Defects ◽  
Koos Score ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background:Autologous chondrocyte implantation (ACI) and microfracture are established treatments for large, full-thickness cartilage defects, but there is still a need to expand the clinical and health economic knowledge of these procedures.Purpose:To confirm the noninferiority of ACI compared with microfracture.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:Patients were randomized to be treated with matrix-associated ACI using spheroid technology (n = 52) or microfracture (n = 50). Both procedures followed standard methods. Patients were assessed by the Knee injury and Osteoarthritis Outcome Score (KOOS), MOCART (magnetic resonance observation of cartilage repair tissue) scoring system, Bern score, modified Lysholm score, International Cartilage Repair Society (ICRS) rating (histological and immunochemical scoring after rebiopsy 24 months after implantation), and International Knee Documentation Committee (IKDC) examination form. The main assessments were conducted 24 months after study treatment.Results:In the primary intention-to-treat analysis, the overall KOOS score for both ACI and microfracture yielded a statistically significant improvement relative to baseline. According to the between-group analysis, ACI passed the test of noninferiority compared with microfracture; thus, the primary goal of the study was achieved. The KOOS subscores yielded the same qualitative results as the overall KOOS score (ie, for each of these, noninferiority was demonstrated), and in 1 case (Activities of Daily Living subscore), the threshold for superiority was passed. The subgroup analyses did not yield any clear evidence of an association between treatment effect and any of the categories investigated (age, diagnosis, defect localization, sex). A histological analysis of biopsies from 16 patients (ACI: n = 9; microfracture: n = 7) suggested a better quality of repair in the patients treated with ACI.Conclusion:The efficacy of both ACI and microfracture was demonstrated with respect to both functional outcomes and morphological repair. The primary analysis confirmed the statistical hypothesis of the noninferiority of ACI, even for relatively small cartilage defects (1-4 cm2) treated in this study, the indication for which microfracture is generally accepted as the standard of care. ACI showed significant superiority in the KOOS subscores of Activities of Daily Living at 24 months and Knee-related Quality of Life at 12 months.Registration:NCT01222559 ( ClinicalTrials.gov identifier).

scholarly journals A Prospective Clinical and Radiological Evaluation at 5 Years After Arthroscopic Matrix-Induced Autologous Chondrocyte Implantation

2016 ◽  
Vol 45 (1) ◽  
pp. 59-69 ◽  
Author(s):  
Jay R. Ebert ◽  
Michael Fallon ◽  
David J. Wood ◽  
Gregory C. Janes
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Knee Extension ◽  
Composite Score ◽  
Physical Component Score ◽  
Knee Extension Strength ◽  
Sf 36 ◽  
Peak Knee ◽  
Chondrocyte Implantation ◽  
Minute Walk ◽  
Autologous Chondrocyte

Background: While midterm outcomes after matrix-induced autologous chondrocyte implantation (MACI) are encouraging, the procedure permits an arthroscopic approach that may reduce the morbidity of arthrotomy and permit accelerated rehabilitation. Hypothesis: A significant improvement in clinical and radiological outcomes after arthroscopic MACI will exist through to 5 years after surgery. Study Design: Case series; Level of evidence, 4. Methods: We prospectively evaluated the first 31 patients (15 male, 16 female) who underwent MACI via arthroscopic surgery to address symptomatic tibiofemoral chondral lesions. MACI was followed by a structured rehabilitation program in all patients. Clinical scores were administered preoperatively and at 3 and 6 months as well as 1, 2, and 5 years after surgery. These included the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee scale (LKS), Tegner activity scale (TAS), visual analog scale for pain, Short Form–36 Health Survey (SF-36), active knee motion, and 6-minute walk test. Isokinetic dynamometry was used to assess peak knee extension and flexion strength and limb symmetry indices (LSIs) between the operated and nonoperated limbs. High-resolution magnetic resonance imaging (MRI) was performed at 3 months and at 1, 2, and 5 years postoperatively to evaluate graft repair as well as calculate the MRI composite score. Results: There was a significant improvement ( P < .05) in all KOOS subscale scores, LKS and TAS scores, the SF-36 physical component score, pain frequency and severity, active knee flexion and extension, and 6-minute walk distance. Isokinetic knee extension strength significantly improved, and all knee extension and flexion LSIs were above 90% (apart from peak knee extension strength at 1 year). At 5 years, 93% of patients were satisfied with MACI to relieve their pain, 90% were satisfied with improving their ability to undertake daily activities, and 80% were satisfied with the improvement in participating in sport. Graft infill ( P = .033) and the MRI composite score ( P = .028) significantly improved over time, with 90% of patients demonstrating good to excellent tissue infill at 5 years. There were 2 graft failures at 5 years after surgery. Conclusion: The arthroscopically performed MACI technique demonstrated good clinical and radiological outcomes up to 5 years, with high levels of patient satisfaction.

scholarly journals Predictors of change over time in subjective daytime sleepiness among older adult recipients of long-term services and supports

2020 ◽  
Vol 32 (7) ◽  
pp. 849-861
Author(s):  
Darina V. Petrovsky ◽  
Karen B. Hirschman ◽  
Miranda Varrasse McPhillips ◽  
Justine S. Sefcik ◽  
Alexandra L. Hanlon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Older Adults ◽  
Depressive Symptoms ◽  
Daytime Sleepiness ◽  
Daily Living ◽  
Services And Supports ◽  
Over Time

ABSTRACTObjectives:Daytime sleepiness is associated with multiple negative outcomes in older adults receiving long-term services and supports (LTSS) including reduced cognitive performance, need for greater assistance with activities of daily living and decreased social engagement. The purpose of this study was to identify predictors of change in subjective daytime sleepiness among older adults during their first 2 years of receiving LTSS.Design and Setting:Secondary analysis of data from a prospective longitudinal study of older adults who received LTSS in their homes, assisted living communities or nursing homes interviewed at baseline and every 3 months for 24 months.Participants:470 older adults (60 years and older) newly enrolled in LTSS (mean = 81, SD = 8.7; range 60–98; 71% women).Measurements:Subjective daytime sleepiness was assessed every 3 months through 2 years using the Epworth Sleepiness Scale. Multiple validated measures were used to capture health-related quality of life characteristics of enrollees and their environment, including symptom status (Symptom Bother Scale), cognition (Mini Mental Status Exam), physical function (Basic Activities of Daily Living), physical and mental general health, quality of life (Dementia Quality of Life, D-QoL), depressive symptoms (Geriatric Depression Scale) and social support (Medical Outcomes Survey-Social Support).Results:Longitudinal mixed effects modeling was used to examine the relationship between independent variables and continuous measure of daytime sleepiness. Increased feelings of belonging, subscale of the D-QoL (effect size = −0.006, 95% CI: −0.013 to −0.0001, p = 0.045) and higher number of depressive symptoms (effect size = −0.002, 95% CI: −0.004 to −0.001, p = 0.001) at baseline were associated with slower rates of increase in daytime sleepiness over time.Conclusions:Comprehensive baseline and longitudinal screening for changes in daytime sleepiness along with depression and perceived quality of life should be used to inform interventions aimed at reducing daytime sleepiness among older adults receiving LTSS.

Analysis of the autologous chondrocyte quality of matrix-based autologous chondrocyte implantation in the knee joint

2015 ◽  
Vol 40 (1) ◽  
pp. 205-212 ◽  
Author(s):  
Thomas R. Niethammer ◽  
Kerstin Limbrunner ◽  
Oliver B. Betz ◽  
Mehmet F. Gülecyüz ◽  
Matthias F. Pietschmann ◽  
...  
Keyword(s):  
Knee Joint ◽  
Autologous Chondrocyte Implantation ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

scholarly journals The Progression of Isokinetic Knee Strength After Matrix-Induced Autologous Chondrocyte Implantation: Implications for Rehabilitation and Return to Activity

2014 ◽  
Vol 23 (3) ◽  
pp. 244-258 ◽  
Author(s):  
Jay R. Ebert ◽  
Anne Smith ◽  
Peter K. Edwards ◽  
Timothy R. Ackland
Keyword(s):  
Outcome Measures ◽  
Knee Flexion ◽  
Autologous Chondrocyte Implantation ◽  
Knee Extensor ◽  
Knee Strength ◽  
Peak Knee ◽  
Chondrocyte Implantation ◽  
Return To Activity ◽  
Over Time ◽  
Autologous Chondrocyte

Context:Matrix-induced autologous chondrocyte implantation (MACI) is an established technique for the repair of knee chondral defects. Despite the reported clinical improvement in knee pain and symptoms, little is known on the recovery of knee strength and its return to an appropriate level compared with the unaffected limb.Objective:To investigate the progression of isokinetic knee strength and limb symmetry after MACI.Design:Prospective cohort.Setting:Private functional rehabilitation facility.Patients:58 patients treated with MACI for full-thickness cartilage defects to the femoral condyles.Intervention:MACI and a standardized rehabilitation protocol.Main Outcome Measures:Preoperatively and at 1, 2, and 5 y postsurgery, patients underwent a 3-repetition-maximum straight-leg raise test, as well as assessment of isokinetic knee-flexor and -extensor torque and hamstring:quadriceps (H:Q) ratios. Correlation analysis investigated the association between strength and pain, demographics, defect, and surgery characteristics. Linear-regression analysis estimated differences in strength measures between the operated and nonoperated limbs, as well as Limb Symmetry Indexes (LSI) over time.Results:Peak knee-extension torque improved significantly over time for both limbs but was significantly lower on the operated limb preoperatively and at 1, 2, and 5 y. Mean LSIs of 77.0%, 83.0%, and 86.5% were observed at 1, 2, and 5 y, respectively, while 53.4–72.4% of patients demonstrated an LSI ≤ 90% across the postoperative timeline. Peak knee-flexion torque was significantly lower on the operated limb preoperatively and at 1 year. H:Q ratios were significantly higher on the operated limb at all time points.Conclusions:While peak knee-flexion and hip-flexor strength were within normal limits, the majority of patients in this study still demonstrated an LSI for peak knee-extensor strength ≤ 90%, even at 5 y. It is unknown how this prolonged knee-extensor deficit may affect long-term graft outcome and risk of reinjury after return to activity.

Correlation of synovial cytokine expression with quality of cells used for autologous chondrocyte implantation in human knees

2014 ◽  
Vol 24 (8) ◽  
pp. 1563-1570 ◽  
Author(s):  
Hagen Schmal ◽  
Alexander T. Mehlhorn ◽  
David Dovi-Akue ◽  
Jan M. Pestka ◽  
Norbert P. Südkamp ◽  
...  
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Cytokine Expression ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Matrix-Associated Autologous Chondrocyte Implantation with Spheroid Technology Is Superior to Arthroscopic Microfracture at 36 Months Regarding Activities of Daily Living and Sporting Activities after Treatment

Cartilage ◽  
2020 ◽  
pp. 194760351989729 ◽  
Author(s):  
Arnd Hoburg ◽  
Philipp Niemeyer ◽  
Volker Laute ◽  
Wolfgang Zinser ◽  
Christoph Becher ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Activities Of Daily Living ◽  
Clinical Outcomes ◽  
Daily Living ◽  
Autologous Chondrocyte Implantation ◽  
Phase Iii ◽  
Cartilage Defects ◽  
Chondrocyte Implantation ◽  
Sport And Recreation ◽  
Autologous Chondrocyte

Objective Matrix-associated autologous chondrocyte implantation (ACI) and microfracture (MF) are well-established treatments for cartilage defects of the knee. However, high-level evidence comparing microfracture and spheroid technology ACI is limited. Design Prospective, phase III clinical trial with patients randomized to ACI ( N = 52) or MF ( N = 50). Level of evidence: 1, randomized controlled trial. Both procedures followed standard protocols. For ACI 10 to 70 spheroids/cm2 were administered. Primary outcome measure was the Knee Injury and Osteoarthritis Outcome Score (KOOS). This report presents results for 36 months after treatment. Results Both ACI and MF showed significant improvement over the entire 3-year observation period. For the overall KOOS, noninferiority of ACI (the intended primary goal of the study) was formally confirmed; additionally, for the subscores “Activities of Daily Living” and “Sport and Recreation,” superiority of ACI over MF was shown at descriptive level. Occurrence of adverse events were not different between both treatments (ACI 77%; MF 74%). Four patients in the MF group required reoperation which was defined as treatment failure. No treatment failure was reported for the ACI group. Conclusions Patients treated with matrix-associated ACI with spheroid technology showed substantial improvement in various clinical outcomes after 36 months. The advantages of ACI compared with microfracture was underlined by demonstrating noninferiority, in overall KOOS and superiority in the KOOS subscores “Activities of Daily Living” and “Sport and Recreation.” In the present study, subgroups comparing different age groups and defect sizes showed comparable clinical outcomes.

Long-term Results of Arthroscopic Matrix-Assisted Autologous Chondrocyte Transplantation: A Prospective Follow-up at 15 Years

2020 ◽  
Vol 48 (12) ◽  
pp. 2994-3001 ◽  
Author(s):  
Luca Andriolo ◽  
Davide Reale ◽  
Alessandro Di Martino ◽  
Roberto De Filippis ◽  
Andrea Sessa ◽  
...  
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Chondrocyte Transplantation ◽  
Previous Surgery ◽  
Duration Of Symptoms ◽  
Chondrocyte Implantation ◽  
Eq Vas ◽  
Over Time ◽  
Autologous Chondrocyte

Background: Matrix-assisted autologous chondrocyte transplantation (MACT) procedures have been developed to overcome some of the limits of first-generation autologous chondrocyte implantation. However, while good autologous chondrocyte implantation results have been documented over time, data are scarce on the long-term MACT results. Purpose: To evaluate long-term clinical results of a large cohort of patients treated with hyaluronic acid–based MACT for articular cartilage defects of the knee. Study Design: Case series; Level of evidence, 4. Methods: A long-term evaluation of 113 patients was performed (91 men, 22 women; mean ± SD age, 29.0 ± 10.6 years) for 115 knees affected by chondral and osteochondral lesions of the femoral condyles and trochlea. Of these, 61 knees had undergone previous surgery, while other procedures were combined during the same operation in 48 knees. These patients were prospectively evaluated before surgery and at 2, 5, and 10 years after surgery, as well as at a final mean follow-up of 15 years (range, 12-18 years), with various clinical scores: International Knee Documentation Committee (IKDC), EuroQol visual analog scale (EQ-VAS), and Tegner. Both surgical and clinical failures were documented. Results: The IKDC subjective score increased from the basal level of 39.9 ± 14.6 (mean ± SD) to 77.3 ± 20.5 ( P < .0005) at 2 years; results remained stable up to the 15-year follow-up (76.9 ± 20.5). EQ-VAS and Tegner scores showed a statistically significant improvement up to 10 years, with a further significant improvement at the final follow-up. A failure rate of 15.0% was documented, which increased to 21.7% when clinical failures were also considered. A worse outcome was found for older age ( P < .0005), female sex ( P = .002), degenerative lesions ( P < .0005), longer duration of symptoms ( P = .005), and previous surgery ( P < .0005). Conclusion: Arthroscopic MACT offered good and long-lasting results that were stable over time and resulted in a limited number of failures and reinterventions for up to 15 years of follow-up. Several factors were identified as having a prognostic value: a worse outcome could be expected in older patients, female patients, those affected by lesions with a degenerative cause, those having a longer duration of symptoms, and patients who underwent previous surgery.

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