scholarly journals Is Delayed Weightbearing After Matrix-Associated Autologous Chondrocyte Implantation in the Knee Associated With Better Outcomes? A Systematic Review of Randomized Controlled Trials

2018 ◽  
Vol 6 (5) ◽  
pp. 232596711877098 ◽  
Author(s):  
Matthew J. Kraeutler ◽  
John W. Belk ◽  
Trevor J. Carver ◽  
Eric C. McCarty
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Autologous Chondrocyte Implantation ◽  
Short Form ◽  
Sf 36 ◽  
Patient Reported ◽  
Rehabilitation Protocols ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: Proper rehabilitation after matrix-associated autologous chondrocyte implantation (MACI) is essential to restore a patient’s normal function without overloading the repair site. Purpose: To evaluate the current literature to assess clinical outcomes of MACI in the knee based on postoperative rehabilitation protocols, namely, the time to return to full weightbearing (WB). Study Design: Systematic review; Level of evidence, 1. Methods: A systematic review was performed to locate studies of level 1 evidence comparing the outcomes of patients who underwent MACI with a 6-week, 8-week, or 10/11-week time period to return to full WB. Patient-reported outcomes assessed included the Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity scale, Short Form Health Survey–36 (SF-36), and visual analog scale (VAS) for pain frequency and severity. Results: Seven studies met the inclusion criteria, including a total of 136 patients (138 lesions) who underwent MACI. Treatment failure had occurred in 0.0% of patients in the 6-week group, 7.5% in the 8-week group, and 8.3% in the 10/11-week group at a mean follow-up of 2.5 years ( P = .46). KOOS, SF-36, and VAS scores in each group improved significantly from preoperatively to follow-up ( P < .001). Conclusion: Patients undergoing MACI in the knee can be expected to experience improvement in clinical outcomes with the rehabilitation protocols outlined in this work. No significant differences were seen in failure rates based on the time to return to full WB.

A 20-Year Follow-up After First-Generation Autologous Chondrocyte Implantation

2017 ◽  
Vol 45 (12) ◽  
pp. 2751-2761 ◽  
Author(s):  
Takahiro Ogura ◽  
Brian A. Mosier ◽  
Tim Bryant ◽  
Tom Minas
Keyword(s):  
Articular Cartilage ◽  
Clinical Outcomes ◽  
Autologous Chondrocyte Implantation ◽  
First Generation ◽  
Short Form ◽  
Cartilage Defects ◽  
Sf 36 ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: Treating articular cartilage defects is a demanding problem. Although several studies have reported durable and improved clinical outcomes after autologous chondrocyte implantation (ACI) over a long-term period, there is no report with over 20 years’ follow-up. Purpose: To evaluate clinical outcomes after first-generation ACI for the treatment of knees with disabling, large single and multiple cartilage defects for which patients wished to avoid prosthetic arthroplasty, with a minimum of 20 years’ follow-up. Study Design: Case series; Level of evidence, 4. Methods: The authors reviewed prospectively collected data from 23 patients (24 knees; mean age, 35.4 years [range, 13-52 years]) undergoing ACI for the treatment of symptomatic, full-thickness articular cartilage lesions. A mean of 2.1 lesions per knee were treated over a mean total surface area of 11.8 cm2 (range, 2.4-30.5 cm2) per knee. Kaplan-Meier survival analysis and functional outcome scores, including the modified Cincinnati Knee Rating System, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form–36 (SF-36), were used. Patients also self-reported an improvement in pain with a visual analog scale and a satisfaction survey. Results: The 20-year survival rate was 63% (95% CI, 40%-78%). The evaluation of the 15 knees with retained grafts demonstrated that all clinical scores except the WOMAC subscore for stiffness and SF-36 mental component summary score improved significantly and were sustained to 20 years postoperatively. Ninety-three percent of these patients rated knee-specific outcomes as good or excellent. The outcomes for 9 of 24 knees were considered failures, including 5 undergoing revision ACI and 4 being converted to arthroplasty at a mean of 1.7 and 5.9 years, respectively. Only 1 of 5 knees that underwent revision ACI was converted to arthroplasty at 1.9 years after the index surgery, and the other 4 patients were able to maintain their biological knee. Overall, 20 years later, 79% of patients maintained their native knee, for which they initially sought treatment, and were satisfied when evaluated. Conclusion: First-generation ACI provided satisfactory survival rates and significant clinical improvements over a 20-year follow-up, which offers an important standard for comparison with newer-generation ACI technologies of the future.

Microfracture Versus Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Knee: A Systematic Review of 5-Year Outcomes

2017 ◽  
Vol 46 (4) ◽  
pp. 995-999 ◽  
Author(s):  
Matthew J. Kraeutler ◽  
John W. Belk ◽  
Justin M. Purcell ◽  
Eric C. McCarty
Keyword(s):  
Systematic Review ◽  
Articular Cartilage ◽  
Clinical Outcomes ◽  
Autologous Chondrocyte Implantation ◽  
Patient Reported Outcome ◽  
Significant Difference ◽  
Patient Reported ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: Microfracture (MFx) and autologous chondrocyte implantation (ACI) are 2 surgical treatment options used to treat articular cartilage injuries of the knee joint. Purpose: To compare the midterm to long-term clinical outcomes of MFx versus ACI for focal chondral defects of the knee. Study Design: Systematic review. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to locate studies (level of evidence I-III) comparing the minimum average 5-year clinical outcomes of patients undergoing MFx versus ACI. Search terms used were “knee,” “microfracture,” “autologous chondrocyte implantation,” and “autologous chondrocyte transplantation.” Patients were evaluated based on treatment failure rates, magnetic resonance imaging, and patient-reported outcome scores (Lysholm, Knee Injury and Osteoarthritis Outcome Score [KOOS], and Tegner scores). Results: Five studies (3 level I evidence, 2 level II evidence) were identified that met the inclusion criteria, including a total of 210 patients (211 lesions) undergoing MFx and 189 patients (189 lesions) undergoing ACI. The average follow-up among all studies was 7.0 years. Four studies utilized first-generation, periosteum-based ACI (P-ACI), and 1 study utilized third-generation, matrix-associated ACI (M-ACI). Treatment failure occurred in 18.5% of patients undergoing ACI and 17.1% of patients undergoing MFx ( P = .70). Lysholm and KOOS scores were found to improve for both groups across studies, without a significant difference in improvement between the groups. The only significant difference in patient-reported outcome scores was found in the 1 study using M-ACI in which Tegner scores improved to a significantly greater extent in the ACI group compared with the MFx group ( P = .003). Conclusion: Patients undergoing MFx or first/third-generation ACI for articular cartilage lesions in the knee can be expected to experience improvement in clinical outcomes at midterm to long-term follow-up without any significant difference between the groups.

Etiology of Cartilage Lesions Does Not Affect Clinical Outcomes of Patellofemoral Autologous Chondrocyte Implantation

Cartilage ◽  
2021 ◽  
pp. 194760352110309
Author(s):  
Alexandre Barbieri Mestriner ◽  
Jakob Ackermann ◽  
Gergo Merkely ◽  
Pedro Henrique Schmidt Alves Ferreira Galvão ◽  
Luiz Felipe Morlin Ambra ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Autologous Chondrocyte Implantation ◽  
Second Generation ◽  
Cartilage Lesion ◽  
Chondrocyte Implantation ◽  
Group 3 ◽  
Group 2 ◽  
Autologous Chondrocyte ◽  
Group 1

Objective To determine the relationship between cartilage lesion etiology and clinical outcomes after second-generation autologous chondrocyte implantation (ACI) in the patellofemoral joint (PFJ) with a minimum of 2 years’ follow-up. Methods A retrospective review of all patients that underwent ACI in the PFJ by a single surgeon was performed. Seventy-two patients with a mean follow-up of 4.2 ± 2.0 years were enrolled in this study and were stratified into 3 groups based on the etiology of PFJ cartilage lesions: patellar dislocation (group 1; n = 23); nontraumatic lesions, including chondromalacia, osteochondritis dissecans, and degenerative defects (group 2; n = 28); and other posttraumatic lesions besides patellar dislocations (group 3; n = 21). Patient’s mean age was 29.6 ± 8.7 years. Patients in group 1 were significantly younger (25.4 ± 7.9 years) than group 2 (31.7 ± 9.6 years; P = 0.025) and group 3 (31.5 ± 6.6 years; P = 0.05). Body mass index averaged 26.2 ± 4.3 kg/m2, with a significant difference between group 1 (24.4 ± 3.2 kg/m2) and group 3 (28.7 ± 4.5 kg/m2; P = 0.005). A clinical comparison was established between groups based on patient-reported outcome measures (PROMs) and failure rates. Results Neither pre- nor postoperative PROMs differed between groups ( P > 0.05). No difference was seen in survivorship between groups (95.7% vs. 82.2% vs. 90.5%, P > 0.05). Conclusion Cartilage lesion etiology did not influence clinical outcome in this retrospective study after second generation ACI in the PFJ. Level of Evidence Level III, retrospective comparative study.

scholarly journals Sporting participation following the operative management of chondral defects of the knee at mid-term follow up: a systematic review and meta-analysis

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
P. G. Robinson ◽  
T. Williamson ◽  
I. R. Murray ◽  
K. Al-Hourani ◽  
T. O. White
Keyword(s):  
Systematic Review ◽  
Autologous Chondrocyte Implantation ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Osteochondral Allograft ◽  
Chondral Defects ◽  
Chondrocyte Implantation ◽  
The Mean ◽  
Autologous Chondrocyte

Abstract Purpose The purpose of this study was to perform a systematic review of the reparticipation in sport at mid-term follow up in athletes who underwent biologic treatment of chondral defects in the knee and compare the rates amongst different biologic procedures. Methods A search of PubMed/Medline and Embase was performed in May 2020 in keeping with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The criteria for inclusion were observational, published research articles studying the outcomes and rates of participation in sport following biologic treatments of the knee with a minimum mean/median follow up of 5 years. Interventions included microfracture, osteochondral autograft transfer (OAT), autologous chondrocyte implantation (ACI), matrix-induced autologous chondrocyte implantation (MACI), osteochondral allograft, or platelet rich plasma (PRP) and peripheral blood stem cells (PBSC). A random effects model of head-to-head evidence was used to determine rates of sporting participation following each intervention. Results There were twenty-nine studies which met the inclusion criteria with a total of 1276 patients (67% male, 33% female). The mean age was 32.8 years (13–69, SD 5.7) and the mean follow up was 89 months (SD 42.4). The number of studies reporting OAT was 8 (27.6%), ACI was 6 (20.7%), MACI was 7 (24.1%), microfracture was 5 (17.2%), osteochondral allograft was 4 (13.8%), and one study (3.4%) reported on PRP and PBSC. The overall return to any level of sport was 80%, with 58.6% returning to preinjury levels. PRP and PBSC (100%) and OAT (84.4%) had the highest rates of sporting participation, followed by allograft (83.9%) and ACI (80.7%). The lowest rates of participation were seen following MACI (74%) and microfracture (64.2%). Conclusions High rates of re-participation in sport are sustained for at least 5 years following biologic intervention for chondral injuries in the knee. Where possible, OAT should be considered as the treatment of choice when prolonged participation in sport is a priority for patients. However, MACI may achieve the highest probability of returning to the same pre-injury sporting level. Level of evidence IV

scholarly journals Outcomes of Joint Preservation Procedures for Cartilage Injuries in the Hip: A Systematic Review and Meta-analysis

2018 ◽  
Vol 6 (6) ◽  
pp. 232596711877694 ◽  
Author(s):  
Michaela O’Connor ◽  
Anas A. Minkara ◽  
Robert W. Westermann ◽  
James Rosneck ◽  
T. Sean Lynch
Keyword(s):  
Systematic Review ◽  
Success Rate ◽  
Hip Joint ◽  
Autologous Chondrocyte Implantation ◽  
Meta Analysis ◽  
Lesion Size ◽  
Joint Preservation ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: The detection and management of chondral injuries of the hip, especially in a younger patient population, may preempt joint degeneration. Although the outcomes of preservation techniques have been well described for other weightbearing joints, such as the knee, evidence for hip joint preservation after procedures such as microfracture and autologous chondrocyte implantation remains in its infancy. Purpose: To evaluate outcomes of joint preservation procedures in the hip, including the success rate and patient-reported outcomes (PROs). Study Design: Systematic review; Level of evidence, 4. Methods: This review was performed using the terms “hip arthroscopy,” “microfracture,” “autologous chondrocyte implantation,” “fibrin glue,” “osteochondral transfer,” and variations thereof in 5 electronic databases, yielding 325 abstracts. After the application of eligibility criteria, 19 articles were included. Weighted means were calculated for PROs, and pooled estimates were calculated for age, follow-up, chondral lesion size, and success of hip preservation procedures with a random-effects proportion meta-analysis. Results: A total of 1484 patients (1502 hips) were identified across 19 studies (mean age, 38.0 ± 1.3 years; mean follow-up, 31.8 ± 9.6 months). Hip joint preservation techniques demonstrated a high success rate, ranging from 85.6% to 99.7%. The mean pooled chondral lesion size was 2.5 ± 0.3 cm2 (95% CI, 1.9-3.0 cm2). Microfracture was the most frequent technique, utilized by 11 studies, and demonstrated an 89.6% success rate (95% CI, 82.4%-96.7%). The highest pooled success rate was exhibited by autologous membrane-induced chondrogenesis in 3 studies (99.7% [95% CI, 99.0%-100.0%]). All PROs demonstrated a statistically significant increase postoperatively, including the modified Harris Hip Score, Nonarthritic Hip Score, and Hip Outcome Score–Activities of Daily Living and Hip Outcome Score–Sports-Specific Subscale (all P < .05). The visual analog scale for pain also demonstrated a statistically significant decrease of 37.2% ( P < .05). Conclusion: Hip preservation procedures demonstrate a high success rate, with microfracture representing the most frequently utilized cartilage preservation technique in the peer-reviewed literature. PROs significantly improved after surgery. Further investigation of hip preservation modalities with long-term follow-up is required to create evidence-based clinical recommendations and treatment algorithms.

scholarly journals Autologous Chondrocyte Implantation to Isolated Patella Cartilage Defects

Cartilage ◽  
2016 ◽  
Vol 8 (2) ◽  
pp. 146-154 ◽  
Author(s):  
Arvind von Keudell ◽  
Roger Han ◽  
Tim Bryant ◽  
Tom Minas
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Outcome Measures ◽  
Autologous Chondrocyte Implantation ◽  
Tibial Tubercle ◽  
Resonance Imaging ◽  
Patient Reported ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background Autologous chondrocyte implantation (ACI) is a durable treatment for patients with chondral defects. This study presents the comprehensive evaluation of patients with patella defects treated with ACI at medium- to long-term follow-up. Methods Thirty consecutive patients with isolated chondral lesions of the patella were enrolled prospectively. Primary outcome measures were validated patient reported outcome measures and objective magnetic resonance imaging. Results Nineteen of 30 patients underwent tibial tubercle osteotomy (TTO) to correct lateral maltracking in combination with soft tissue balancing. The defect sizes were large, averaging 4.7 ± 2.1 cm2 (range 2.2-30.0 cm2). Pidoriano/Fulkerson classification revealed that 3 defects were type II (lateral), 9 were type III (medial), and 18 were type IV (central/panpatella). Age at the time of surgery was 32 ± 10 years. At follow-up of 2 to 14 years, knee function was rated good to excellent in 25 (83%) patients, fair in 4 (13%) patients, and poor in 1 (3%) patient. Three patients failed treatment after a mean of 75 months (6.25 years). All 3 failures were Workers Compensation (WC) cases. They were older than the non-WC patients, 42 ± 6 years compared with the non-WC 28 ± 9 years ( P = 0.0019). Significant increases in all clinical and health utility outcome scores were seen. Magnetic resonance imaging demonstrated that the fill grade, surface and integrity of the repair tissue correlated with clinical scores. Conclusion ACI to isolated patella defects results in significant functional improvement at a minimum of 24 months, with the results remaining durable at latest follow-up of 15 years. Level of evidence Level 4.

Repair of Large Chondral Defects of the Knee with Autologous Chondrocyte Implantation in Patients 45 Years or Older

2008 ◽  
Vol 36 (12) ◽  
pp. 2336-2344 ◽  
Author(s):  
Ralf E. Rosenberger ◽  
Andreas H. Gomoll ◽  
Tim Bryant ◽  
Tom Minas
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Rating Scales ◽  
Rating Scale ◽  
Short Form ◽  
Case Series ◽  
Younger Patients ◽  
Chondral Defects ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background Autologous chondrocyte implantation (ACI) has become an accepted option for the treatment of chondral defects in carefully selected patients. Current recommendations limit this procedure to younger patients, as insufficient data are available to conclusively evaluate outcomes in patients older than 45 years. Hypothesis Cartilage repair with ACI in patients older than 45 years results in substantially different outcomes than those previously reported for younger age groups. Study Design Case series; Level of evidence, 4. Methods This prospective cohort study reviewed patients 45 years of age at the time of treatment with ACI. The clinical evaluation included a patient satisfaction questionnaire and four validated rating scales: Short Form-36, Modified Cincinnati Rating Scale, WOMAC (Western Ontario and McMaster Universities) Osteoarthritis Index, and the Knee Society Score. Results A total of 56 patients 45 years of age were treated with ACI. The average patient age at index surgery was 48.6 years (range, 45–60 years). The minimum follow-up was 2 years (range, 2–11 years; mean, 4.7 years). The cohort included 36 men and 20 women. The mean transplant size was 4.7 cm2 per defect (range, 1–15.0 cm2) and 9.8 cm2 per knee (range, 2.5–31.6 cm2). Twenty-eight patients (50%) underwent concomitant osteotomies to address malalignment. There were 8 failures (14%); 6 of 15 (40%) in patients receiving workers’ compensation (WC) and 2 of 41 (4.9%) in non-WC patients. Additional arthroscopic surgical procedures were required in 24 patients (43%) for periosteal-related problems and adhesions; 88% of these patients experienced lasting improvement. At their latest available follow-up, 72% of patients rated themselves as good or excellent, 78% felt improved, and 81 % would again choose ACI as a treatment option. Conclusion Our results showed a failure rate of ACI in older patients that is comparable with rates reported in younger patient groups. The procedure is associated with a substantial rate of reoperations, mostly for the arthroscopic treatment of graft hypertrophy, similar to that in younger patients.

Arthroscopic Versus Open Matrix-Induced Autologous Chondrocyte Implantation: Results and Implications for Rehabilitation

2014 ◽  
Vol 23 (3) ◽  
pp. 203-215 ◽  
Author(s):  
Peter K. Edwards ◽  
Jay R. Ebert ◽  
Gregory C. Janes ◽  
David Wood ◽  
Michael Fallon ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Outcome Measures ◽  
Autologous Chondrocyte Implantation ◽  
Short Form ◽  
Cartilage Defects ◽  
Early Results ◽  
Patient Reported ◽  
Chondrocyte Implantation ◽  
Open Arthrotomy ◽  
Autologous Chondrocyte

Context:Matrix-induced autologous chondrocyte implantation (MACI) has become an established technique for the repair of chondral defects in the knee. MACI has traditionally required an open arthrotomy, but now lends itself to an arthroscopic technique, which may decrease the associated comorbidity of arthrotomy, potentially allowing for faster rehabilitation.Objective:To compare postoperative outcomes between arthroscopic and open arthrotomy techniques of MACI and present a case for faster recovery and accelerated rehabilitation after surgery.Design:Retrospective cohort study.Setting:Private functional rehabilitation facility.Patients:78 patients (41 arthroscopic, 37 open) treated with MACI for full-thickness cartilage defects to the femoral condyles.Intervention:According to surgeon preference, patients recruited over the same time period underwent MACI performed arthroscopically or via a conventional open arthrotomy. Both surgical groups were subjected to an identical rehabilitation protocol.Main Outcome Measures:Patient-reported (Knee Injury and Osteoarthritis Outcome Score, Short Form Health Survey, and visual analogue scale) and functional (6-min-walk test, 3-repetition straight-leg-raise test [3R-SLR]) outcomes were compared presurgery and at 3, 6, and 12 mo postsurgery. Active knee range of motion (ROM) was additionally assessed 4 and 8 wk postsurgery. MRI evaluation was assessed using magnetic-resonance observation of cartilage-repair tissue (MOCART) scores at 3 and 12 mo. The length of hospital stay was evaluated, while postsurgery complications were documented.Results:Significant improvements (P < .05) for both groups were observed over the 12-mo period for patient-reported and functional outcomes; however, the arthroscopic cohort performed significantly better (P < .05) in active knee-flexion and -extension ROM and the 3R-SLR. No differences were observed in MOCART scores between the 2 groups at 12 mo. Patients who received arthroscopic implantation required a significantly reduced (P < .001) hospital stay and experienced fewer postoperative complications.Conclusions:Arthroscopic MACI in combination with “best practice” rehabilitation has shown encouraging early results, with good clinical outcomes to 12 mo, reduced length of patient hospitalization, and reduced risk of postsurgery complications. This may have important implications for postoperative rehabilitation and a faster return to full function.

scholarly journals Prospective Long-term Follow-up of Autologous Chondrocyte Implantation With Periosteum Versus Matrix-Associated Autologous Chondrocyte Implantation: A Randomized Clinical Trial

2020 ◽  
Vol 48 (9) ◽  
pp. 2230-2241
Author(s):  
Alexander Barié ◽  
Patrizia Kruck ◽  
Reza Sorbi ◽  
Christoph Rehnitz ◽  
Doris Oberle ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Autologous Chondrocyte Implantation ◽  
Cartilage Defects ◽  
Repair Tissue ◽  
Sf 36 ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte ◽  
Time Point

Background: Matrix-associated autologous chondrocyte implantation (MACI) is a further development of the original autologous chondrocyte implantation periosteal flap technique (ACI-P) for the treatment of articular cartilage defects. Purpose: We aimed to establish whether MACI or ACI-P provides superior long-term outcomes in terms of patient satisfaction, clinical assessment, and magnetic resonance imaging (MRI) evaluation. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 21 patients with cartilage defects at the femoral condyle were randomized to MACI (n = 11) or ACI-P (n = 10) between the years 2004 and 2006. Patients were assessed for subjective International Knee Documentation Committee (IKDC) score, Lysholm and Gillquist score, Tegner Activity Score, and 36-Item Short Form Health Survey (SF-36) preoperatively (T0), at 1 and 2 years postoperatively (T1, T2), and at the final follow-up 8 to 11 years after surgery (T3). Onset of osteoarthritis was determined using the Kellgren-Lawrence score and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, and delayed gadolinium-enhanced MRI of cartilage was used to evaluate the cartilage. Adverse events were recorded to assess safety. Results: There were 16 patients (MACI, n = 9; ACI-P, n = 7) who were reassessed on average 9.6 years after surgery (76% follow-up rate). The Lysholm and Gillquist score improved in both groups after surgery and remained elevated but reached statistical significance only in ACI-P at T1 and T2. IKDC scores increased significantly at all postoperative evaluation time points in ACI-P. In MACI, IKDC scores showed a significant increase at T1 and T3 when compared with T0. In the majority of the patients (10/16; MACI, 5/9; ACI-P, 5/7) a complete defect filling was present at the final follow-up as shown by the MOCART score, and 1 patient in the ACI-P group displayed hypertrophy of the repair tissue, which represents 6% of the whole study group and 14.3% of the ACI-P group. Besides higher SF-36 vitality scores in ACI-P at T3, no significant differences were seen in clinical scores and MRI scores between the 2 methods at any time point. Revision rate was 33.3% in MACI and 28.6% in ACI-P at the last follow-up. Conclusion: Our long-term results suggest that first- and third-generation ACI methods are equally effective treatments for isolated full-thickness cartilage defects of the knee. With the number of participants available, no significant difference was noted between MACI and ACI-P at any time point. Interpretation of our data has to be performed with caution due to the small sample size, which was further limited by a loss to follow-up of 24%.

Equivalent 10-Year Outcomes After Implantation of Autologous Bone Marrow–Derived Mesenchymal Stem Cells Versus Autologous Chondrocyte Implantation for Chondral Defects of the Knee

2019 ◽  
Vol 47 (12) ◽  
pp. 2881-2887 ◽  
Author(s):  
Alex Quok An Teo ◽  
Keng Lin Wong ◽  
Liang Shen ◽  
Jia Ying Lim ◽  
Wei Seong Toh ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Tumor Formation ◽  
Chondral Defects ◽  
Sf 36 ◽  
Significant Difference ◽  
Patient Reported ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: The use of bone marrow–derived mesenchymal stem cells (BMSCs) in cartilage repair procedures circumvents some of the limitations of autologous chondrocyte implantation (ACI), but long-term outcomes for this newer procedure are lacking. The authors previously reported comparable outcomes for the 2 procedures at 2-year follow-up. Purpose/Hypothesis: The purpose was to compare the long-term clinical outcomes of ACI versus BMSCs. It was hypothesized that there would be no significant difference between the groups in terms of patient-reported outcome scores and safety outcomes at 10-year follow-up. Study Design: Cohort study; Level of evidence, 2. Methods: Seventy-two patients who underwent either ACI or BMSC implantation—matched in terms of age and lesion site— were followed up to a median of at least 10 years. Patients were assessed with the 36-item Short Form Health Survey (SF-36), the International Knee Documentation Committee knee evaluation form, the Lysholm Knee Score, and the Tegner Activity Scale. In addition, information was obtained regarding any additional surgical procedures as well as safety data, with particular attention to infection and tumor formation. Results: There was an improvement in all patient-reported outcomes scores apart from the Mental Component Summary of the SF-36 after cartilage repair surgery. There was no significant difference in any of the patient-reported outcomes between cohorts at any time point. Six and 5 patients in the ACI and BMSC groups, respectively, underwent subsequent surgical procedures, including 1 total knee replacement in the BMSC group. None of the patients in either group developed any deep infection or tumor within the follow-up period. Conclusion: BMSC implantation used for the treatment of chondral defects of the knee appears to result in equivalent clinical outcomes to first-generation ACI at up to 10 years, with no apparent increased tumor formation risk.

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