Knee articular cartilage injury treatment with matrix-induced autologous chondrocyte implantation (MACI): correlation at 24 and 120 months between clinical and radiological findings using MR arthrography

Abstract

Objective To evaluate the long-term evolution of matrix-induced autologous chondrocyte implantation (MACI) with magnetic resonance (MR) arthrography and verify the correlation between radiological and clinical findings. Materials and methods Twenty-six patients (20 m/6f) were diagnosed with knee chondral injuries and treated with MACI implantation. Each patient received MR arthrography and clinical examination at mid-term (range 22–36 months) and long term (range 96–194 months) after surgery. MR arthrography was performed with dedicated coil and a 1.5-Tesla MR unit. The modified MOCART scale was used to evaluate the status of chondral implants. Implant coating, integration to the border zone, and the surface and structure of the repaired tissue were evaluated. Presence of bone marrow oedema was evaluated. The Cincinnati Knee Rating System (CKRS) was used for clinical assessment. Results At long term, 4/26 patients had complete alignment; 5/26 had a complete integration of the margins; in 4/26 cases, the implant surface was undamaged; in 14/26 cases, the reparative tissue was homogeneous. In 9/26 cases, the implant showed isointense signal compared to articular cartilage, while the presence of subchondral bone oedema was documented in 19/26 cases. The average radiological score decreased from 59.2 (mid-term) to 38.6 (long term). The average clinical score decreased from 8.9 to 8.3. Conclusions Decrease in clinical results was not significant (0.6 points p = .06), but mMOCART scores decreased significantly (p = .00003). Although imaging studies showed deterioration of the grafts, the patients did not have significant clinical deterioration (231/250).

Loose Body Versus Trochlear Biopsy Matrix-Induced Autologous Chondrocyte Implantation (MACI) MOCART Scores and IKDC Reported Outcomes in Pediatric Patients

“…A post hoc power analysis determined that each treatment group would require 14 patients to detect an overall difference of 20 in MOCART scores. 33 Although IKDC findings were similar and unlikely to change with a larger patient population, it is possible that the study design resulted in a type II statistical error and failure to identify a statistically significant difference in median MOCART scores. However, sampling error may also confound results as patients with lesions large enough to produce sizeable loose bodies may have presented with radiographic evidence of more severe OCLs.…”

“…The main limitation of this study was the small sample size. A post hoc power analysis determined that each treatment group would require 14 patients to detect an overall difference of 20 in MOCART scores 33. Although IKDC findings were similar and unlikely to change with a larger patient population, it is possible that the study design resulted in a type II statistical error and failure to identify a statistically significant difference in median MOCART scores.…”

The Predictive Value of Early Postoperative MRI-Based Bone Marrow Parameters for Mid-Term Outcome after MACI with Autologous Bone Grafting at the Knee

“…Several studies have described large numbers of patients with BMEL after cartilage repair surgery, with a prevalence of up to 47% at 12 months follow-up, and 61.5% and 73.1% at mid-term (22-36 months) and long-term (96-194) months' follow-up, respectively. [38][39][40][41][42][43] While previous studies reported associations of BMEL with knee pain, 5,6,44,45 some postoperative follow-up studies after cartilage repair surgery found no correlation of BMEL with poor clinical outcomes. 40,41,46,47 In this prospective study, larger early postoperative BMEL was associated with worse clinical outcome after 24 months, and BMEL volume measurements showed good to excellent accuracy in predicting the clinical outcome at 2-year follow-up after MACI with ABG (optimal cutoff at 6 months: ≤7.0 cm 3 ).…”

Treatment of Cartilage Defects of the Knee in Military Tactical Athletes: An Overview of Management and Clinical Outcomes

“…40 These findings are echoed throughout the literature with ACI having good clinical efficacy and integration of MRI at a minimum of 5year outcomes for repair of full-thickness cartilage defects in the knee. [41][42][43][44][45] A study of 88 patients who underwent MACI procedure for full-thickness cartilage lesions with an average size of 4.28 cm 2 found significant improvement in outcomes at 2 years postoperatively, showing that this procedure is successful even with very large lesions. 46 In the athletic population, multiple studies have shown return to sport at or above preinjury level of 67 to 74%.…”