Long-term follow-up evaluation of autologous chondrocyte implantation for symptomatic cartilage lesions of the knee: A single-centre prospective study

Berruto, Massimo; Ferrua, Paolo; Pasqualotto, Stefano; Uboldi, Francesco; Maione, Alessio; Tradati, Daniele; Usellini, E.

doi:10.1016/j.injury.2017.08.005

Cited by 22 publications

(21 citation statements)

References 23 publications

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“…However, MACI showed significant long-lasting improvements in subjective IKDC and SF-36 physical health scores. The comparison between both groups revealed that only the vitality subscale of SF-36 at the final evaluation time point showed significantly higher scores for ACI-P. Our findings are consistent with the limited number of studies published on the comparison between different generations of ACI 2,3,20,24 or comparison of ACI with other techniques such as microfracture. 14 The largest retrospective study was published by Nawaz et al, 24 who evaluated the functional outcome of 827 patients who received either ACI with Chondron and periosteum (ACI-C/ACI-P) or MACI.…”

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

“…Even though third-generation ACI is considered to present the highest treatment standard, the superiority of this advancement is not well-supported by clinical studies, and few studies have addressed whether higher generation ACI results in superior clinical outcome. 2,3,10,20,24,27,40 To the best of our knowledge, this is the first randomized controlled trial with a follow-up of almost 10 years comparing the original technique (ACI-P) with the third-generation technique (MACI). Interpretation of our data has to be Mental health T0:T1 P = .887 T0:T2 P .999 T0:T3 P = .725 T1:T2 P .999 T1:T3 P = .623 T2:T3 P = .717 T0:T1 P = .141 T0:T2 P = .932 T0:T3 P = .149 T1:T2 P = .340 T1:T3 P = .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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%.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Encouraging longer term clinical outcomes have been reported for earlier ACI generations. 5,33,35 Other surgical procedures exist in treating symptomatic knee chondral defects including osteoarticular transplant system and microfracture. Although limited in number, studies have shown the clinical superiority of MACI over procedures such as microfracture in the earlier stages and now up to 5 years after surgery.…”

Section: Discussionmentioning

confidence: 99%

Minimum 10-Year Clinical and Radiological Outcomes of a Randomized Controlled Trial Evaluating 2 Different Approaches to Full Weightbearing After Matrix-Induced Autologous Chondrocyte Implantation

Ebert

Fallon²,

Ackland

et al. 2019

Am J Sports Med

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Background: Longer term outcomes after matrix-induced autologous chondrocyte implantation (MACI) are lacking, while early postoperative weightbearing (WB) management has traditionally been conservative. Purpose: To investigate the longer term clinical and radiological outcomes after an 8-week (vs 12-week) WB protocol after MACI. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A randomized study design allocated 70 patients to an 8- (n = 34) or 12-week (n = 36) approach to full WB after MACI of the medial or lateral femoral condyle. Patients were evaluated preoperatively; at 3, 12, and 24 months after surgery; and at 5 and 10 years after surgery. At 10 years (range, 10.5-11.5 years), 60 patients (85.7%; 8 weeks: n = 29; 12 weeks: n = 31) were available for review. Clinical outcomes included patient-reported outcomes, maximal isokinetic knee extensor and flexor strength, and functional hop capacity. High-resolution magnetic resonance imaging (MRI) was undertaken to assess the quality and quantity of repair tissue per the MOCART (magnetic resonance observation of cartilage repair tissue) system. A combined MRI composite score was also evaluated. Results: Clinical and MRI-based scores for the full cohort significantly improved ( P < .05) over the 10-year period. Apart from the Tegner activity score, which improved ( P = .041), as well as tissue structure ( P = .030), which deteriorated, there were no further statistically significant changes ( P > .05) from 5 to 10 years. There were no 10-year differences between the 2 WB rehabilitation groups. At 10 years, 81.5% and 82.8% of patients in the 8- and 12-week groups, respectively, demonstrated good-excellent tissue infill. Graft failure was observed on MRI at 10 years in 7 patients overall, which included 4 located on 10-year MRI (8 weeks: n = 1; 12 weeks: n = 3) and a further 3 patients (8 weeks: n = 1; 12 weeks: n = 2) not included in the current analysis who proceeded to total knee arthroplasty. At 10 years, 93.3% of patients were satisfied with MACI for relieving their pain, with 83.3% satisfied with their ability to participate in sport. Conclusion: MACI provided high satisfaction levels and tissue durability beyond 10 years. The outcomes of this randomized trial demonstrate a safe 8-week WB rehabilitation protocol without jeopardizing longer term outcomes.

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“…Among these methods, ACI is a valid technique for the treatment of full‐thickness articular cartilage defects in the knee and has obtained promising clinical remission in the early stage. However, the long‐term follow‐up revealed that the fibrocartilage regenerated in the defect mainly due to the insufficient mechanical support and microenvironment‐induced dedifferentiation, and finally led to gradual degeneration of cartilage …”

Section: Introductionmentioning

confidence: 99%

Injectable Cholesterol‐Enhanced Stereocomplex Polylactide Thermogel Loading Chondrocytes for Optimized Cartilage Regeneration

Wang

Feng

Chang

et al. 2019

Adv Healthcare Materials

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Ideal cartilage tissue engineering requires scaffolds featuring good biocompatibility, large pore structure, high mechanical strength, as well as minimal invasion procedure. Although significant progress has been made in the development of polymer scaffolds, the construction of smart systems with all the desired properties is still emerging as a challenge. The thermogels of stereocomplex 4‐arm poly(ethylene glycol)–polylactide (PEG–PLA) (scPLAgel) and stereocomplex cholesterol‐modified 4‐arm PEG–PLA (scPLA–Cholgel) from the equimolar enantiomeric 4‐arm PEG–PLA and 4‐arm PEG–PLA–Chol, respectively, are fabricated as scaffolds for cartilage tissue engineering. scPLA–Cholgel shows lower critical gelation temperature, higher mechanical strength, larger pore size, better chondrocyte adhesion, and slower degradation compared to scPLAgel as the benefit of cholesterol modification, which is more appropriate for cartilage regeneration. Moreover, the preservation of morphology, biomechanical property, cartilaginous specific matrix, as well as cartilaginous gene expressions of engineered cartilage mediated by scPLA–Cholgel are proven superior to those by scPLAgel. scPLA–Cholgel serves as a promising chondrocyte carrier for cartilage tissue engineering and gives an alternative solution to clinical cartilage repair.

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Long-term follow-up evaluation of autologous chondrocyte implantation for symptomatic cartilage lesions of the knee: A single-centre prospective study

Cited by 22 publications

References 23 publications

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

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

Minimum 10-Year Clinical and Radiological Outcomes of a Randomized Controlled Trial Evaluating 2 Different Approaches to Full Weightbearing After Matrix-Induced Autologous Chondrocyte Implantation

Injectable Cholesterol‐Enhanced Stereocomplex Polylactide Thermogel Loading Chondrocytes for Optimized Cartilage Regeneration

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