Arthroscopic Matrix-Induced Autologous Chondrocyte Implantation: 2-Year Outcomes

Ebert, Jay R.; Fallon, Michael B.; Ackland, Tim; Wood, David; Janes, Gregory C.

doi:10.1016/j.arthro.2011.12.022

Cited by 58 publications

(87 citation statements)

References 38 publications

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“…Therefore, in this review, 10 of the 16 studies are from the same research group (5 case series 12,13,16,19,59 and 5 randomized controlled trials [RCTs] 14,15,17,18,20 of rehabilitation weight-bearing protocols), which could contribute to bias in the interpretation of the findings across the studies. The average  SD total modified Coleman Methodology Score was 68  11, with the highest score being 85 14 and the lowest score 52.…”

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confidence: 99%

“…Of the 16 included studies, 3 evaluated outcomes following MF techniques 24,68,69 and 15 studies [12][13][14][15][16][17][18][19][20]39,40,47,59,68,69 evaluated outcomes following chondrocyte implantation techniques. Preoperative data were reported in 6 studies, 13,14,17,59,68,69 and postoperative follow-ups ranged from 3 months to 7.4 years postprocedure. Across both MF and ACI procedures, 7 studies provided data on muscle performance, 16,18,20,39,40,47,68 3 studies from the same group provided data on knee biomechanics and joint loading, 12,15,18 and 10 studies reported on performance-based functional outcomes.…”

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confidence: 99%

“…Among the 16 included studies, there were 8 level IV studies, 12,13,16,19,24,40,47,59 all with prospective designs, 4 comparing outcomes between the involved and uninvolved limbs, 16,24,40,47 4 comparing outcomes over time, 13,19,47,59 1 reporting outcomes between males and females, 16 and 1 evaluating limb-loading postoperatively. 12 One study was a level III study, with the primary analysis comparing outcomes of males and females.…”

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“…40,47 Items with the highest average scores were for diagnostic certainty and outcome criteria (description of outcome measures, timing of assessment, and use of outcomes with good reliability and sensitivity). Items with lower average item scores were for type of study and procedure of outcome assessment.In terms of lesion location, 6 studies 19,24,39,40,47,59 included participants with lesions in the tibiofemoral (medial/ lateral femoral condyle, tibial plateau)With cartilage terms plus English language/humans filter (searches 1 and 2), n = 7326 Initial search (with variables of interest, searches 4, 5, 6, 7 and removed duplicates), n = 2612 • Outcomes related to muscle performance (search 4), n = 421 • Outcomes related to biomechanics/joint loading (search 5), n = 401 • Outcomes related to performance-based function (search 6), n = 1403 • Outcomes related to rehabilitation protocols (search 7), n = 387Excluded based on animal and cadaver studies (not found by filter), cartilage defects in other joints (not the knee), concomitant or additional surgeries performed with cartilage procedure, n = 762Excluded based on patient population of interest (eg, osteoarthritis, pediatric); outcome measures not related to performance-based measures (eg, patient-reported outcomes only); outcomes pertaining to histology, imaging, or surgery (eg, adverse events); or surgical-technique studies, n = 1834 and patellofemoral (patella, trochlea) compartments, and 10 studies [12][13][14][15][16][17][18]20,68,69 included only those with lesions in the tibiofemoral compartments (medial/ lateral condyle, tibial plateau). Of the 16 included studies, 3 evaluated outcomes following MF techniques 24,68,69 and 15 studies [12][13][14][15][16][17][18][19][20]39,40,…”

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confidence: 99%

“…Excluded based on patient population of interest (eg, osteoarthritis, pediatric); outcome measures not related to performance-based measures (eg, patient-reported outcomes only); outcomes pertaining to histology, imaging, or surgery (eg, adverse events); or surgical-technique studies, n = 1834 and patellofemoral (patella, trochlea) compartments, and 10 studies [12][13][14][15][16][17][18]20,68,69 included only those with lesions in the tibiofemoral compartments (medial/ lateral condyle, tibial plateau). Of the 16 included studies, 3 evaluated outcomes following MF techniques 24,68,69 and 15 studies [12][13][14][15][16][17][18][19][20]39,40,47,59,68,69 evaluated outcomes following chondrocyte implantation techniques.…”

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confidence: 99%

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Functional Outcomes After Surgical Management of Articular Cartilage Lesions in the Knee: A Systematic Literature Review to Guide Postoperative Rehabilitation

Schmitt¹,

Quatman²,

Paterno³

et al. 2014

J Orthop Sports Phys Ther

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A rticular cartilage injuries are relatively common in the knee and pose a significant problem due to the poor healing potential and long-term disability associated with these lesions. 7,31 In 2 large-scale studies of more than 25 000 knee arthroscopies, 60% of the operated knees demonstrated articular cartilage lesions. 11,74 Approximately 5% to 27% of patients younger than 45 years of age have articular cartilage lesions identified at arthroscopy, 3,11,31,74 and active individuals may be at even higher risk for articular cartilage injury than the general population. 22 In the short term, these lesions may lead to a loss of function and a significant decline in activity participation. 22,25 Although the T T STUDY DESIGN: Systematic literature review. T T OBJECTIVE:To systematically review the literature relative to muscle performance, knee joint biomechanics, and performance-based functional outcomes following articular cartilage repair and restoration surgical procedures in the knee. T T BACKGROUND:Articular cartilage injuries are associated with functional limitations, poor quality of life, and the potential for long-term disability. This review systematically evaluates evidence related to muscle performance, joint biomechanics, and performance-based functional outcomes following articular cartilage procedures, and discusses their implications for rehabilitation. T T METHODS:The online databases of PubMed (MEDLINE), CINAHL, SPORTDiscus, and Scopus were searched (inception to September 2013). Studies pertaining to muscle performance, knee joint biomechanics, and performance-based measures of function following articular cartilage procedure in the knee were included. T T RESULTS:Sixteen articles met the specified inclusion criteria. Seven studies evaluated muscle performance, all showing persistent deficits in quadriceps femoris muscle strength for up to 7 years postprocedure. Quadriceps femoris strength deficits of greater than 20% were noted in 33% and 26% of individuals at 1 and 2 years following microfracture and autologous chondrocyte implantation (ACI), respectively. Two studies evaluated knee mechanics post-ACI, showing persistent deficits in knee kinematics and kinetics for up to 12 months postprocedure compared to uninjured individuals. Seven studies showed improved functional capacity (6-minute walk test) over time, and 3 studies showed persistent performance deficits during higher-level activities (single-leg hop test) for up to 6 years postprocedure. Five studies comparing weight-bearing protocols (accelerated versus traditional/current practice) following ACI found few differences between the groups in function and gait mechanics; however, persistent gait alterations were observed in both groups compared to uninjured individuals. T T CONCLUSION:Significant quadriceps femoris strength deficits, gait deviations, and functional deficits persist for 5 to 7 years following ACI and microfracture surgical procedures. Future research regarding rehabilitation interventions to help mitigate these deficits is...

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confidence: 99%

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confidence: 99%

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Functional Outcomes After Surgical Management of Articular Cartilage Lesions in the Knee: A Systematic Literature Review to Guide Postoperative Rehabilitation

Schmitt¹,

Quatman²,

Paterno³

et al. 2014

J Orthop Sports Phys Ther

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Autologous chondrocyte implantation, matrix‐induced autologous chondrocyte implantation, osteochondral autograft transplantation and osteochondral allograft improve knee function and pain with considerations for patient and cartilage defects characteristics: A systematic review and meta‐analysis

Nassar,

Guerin,

Keel

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposePrevious studies have reported on the outcomes of autologous chondrocyte implantation (ACI) versus matrix‐induced ACI (MACI) and microfracture. Specific clinical outcomes of ACI, MACI, osteochondral autograft transplantation (OAT) and osteochondral allograft (OCA) have not been well studied. The purpose of this systematic review and meta‐analysis was to analyze the outcomes of these regenerative surgical techniques with an emphasis on comparing their effectiveness using the International Knee Documentation Committee (IKDC) subjective score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and the Visual Analogue Scale (VAS) score for the surgical treatment of tibiofemoral joint cartilage defects.MethodsAn electronic search of MEDLINE, Embase and Cochrane Library was performed to identify studies that reported clinical outcomes for ACI, MACI, OAT and OCA procedures. The literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines and only studies involving cartilage defects in the tibiofemoral joint were included. Outcomes were measured with the IKDC evaluation, Lysholm Knee Scoring Scale, Tegner Activity Scale and the VAS. Outcomes were compared to the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). The methodological quality of the included studies was analyzed by the Methodological Index for Nonrandomized Studies and the Jadad scale.ResultsForty‐seven studies were included representing a total of 1993 patients with a mean follow‐up time of 57.2 ± 40.3 months (range: 4.0–160.0 months). The location of cartilage defects was reported in 46 studies, with a total of 1922 cartilage defects. There were 1277 medial femoral condyle cartilage defects, 488 lateral femoral condyle cartilage defects, 139 unspecified femoral condyle cartilage defects and 18 tibial plateau cartilage defects. All four procedures reported significant improvements in the Lysholm, IKDC, Tegner and VAS scores with no significant differences between them. The OAT technique surpassed the PASS threshold for the IKDC score while all four techniques surpassed the PASS threshold for Tegner and Lysholm scores. Additionally, all procedures met the MCID for each clinical outcome.ConclusionThis systematic review and meta‐analysis indicate that ACI, MACI, OAT and OCA all result in significant improvements in knee function and pain for cartilage defects of the tibiofemoral joint. When selecting a procedure, patient and cartilage defect characteristics should be assessed to determine the best technique for each individual patient.Study DesignSystematic review and meta‐analysis.Level of EvidenceLevel III.

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Gene Therapy in Articular Cartilage Repair

Ivković

Vukasović

Porter

et al. 2013

Developing Insights in Cartilage Repair

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Arthroscopic Matrix-Induced Autologous Chondrocyte Implantation: 2-Year Outcomes

Cited by 58 publications

References 38 publications

Functional Outcomes After Surgical Management of Articular Cartilage Lesions in the Knee: A Systematic Literature Review to Guide Postoperative Rehabilitation

Functional Outcomes After Surgical Management of Articular Cartilage Lesions in the Knee: A Systematic Literature Review to Guide Postoperative Rehabilitation

Autologous chondrocyte implantation, matrix‐induced autologous chondrocyte implantation, osteochondral autograft transplantation and osteochondral allograft improve knee function and pain with considerations for patient and cartilage defects characteristics: A systematic review and meta‐analysis

Gene Therapy in Articular Cartilage Repair

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