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

Abstract

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.

Three-dimensional, Scaffold-Free, Autologous Chondrocyte Transplantation: A Systematic Review

“…The search included 10 studies 11 , 12 , 14 , 15 , 19 , 20 , 29 , 33 , 34 , 36 that fulfilled the inclusion criteria: 2 randomized controlled trials, 15 , 19 7 case series, 11 , 12 , 19 , 20 , 33 , 34 , 36 and 1 cohort study. 14 Of the 10 studies, 6 studies addressed ACT3D of articular cartilage defects in the knee joint, 11 , 14 , 15 , 29 , 33 , 34 and 4 publications investigated the outcome of ACT3D therapy in affected hip joints. 12 , 19 , 20 , 36 The mean defect size of the treated lesions ranged from 2 to 6 cm 2 .…”

“…Additionally, most of the publications lacked a suitable control group. One randomized controlled trial compared ACT3D with microfracture, 15 which is an important step, but there are no works contrasting ACT3D with other ACT methods.…”

“…Most recently, Hoburg et al 15 compared spheroid-based ACT versus microfracture, the currently recommended first-line treatment for small cartilage defects. The 3-year follow-up analysis of the randomized controlled trial using MRI and clinical scores revealed the equality of both therapy options for defects between 1 and 4 cm 2 .…”

“…Hoburg (2019) adults 14 92.9 ± 7.9 (n ¼ 30) Siebold (2018) 34 77.7 ± 14.6 (n ¼ 30) Siebold (2016) 33 79.0 ± 18.0 (n ¼ 31) Fickert (2012) 11 82. 34 84.2 ± 5.6 (n ¼ 30) Siebold (2016) 33 63.0 ± 18.8 (n ¼ 31) Fickert (2012) 11 64.0 (n ¼ 37) Weighted average 73.5 (n ¼ 147) KOOS (overall) Hoburg (2020) 15,28 83.2 ± 14.9 (n ¼ 48) Niemeyer (2020) 5,27,29 77. 34 used a maximum MOCART score of 85 rather than 100; to compare their results with those of the other studies, we used the percentage instead of the absolute value.…”

Is There a Role for Cartilage Imaging in Athletes?

“…[58][59][60] MACI is now considered a reliable option for patients seeking to return to sports and professional athletics involv-ing high-impact joint forces because it offers superior results in comparison with allograft transfer and microfracture surgery. 61,62 The failure rate of ACI reported significantly increased after previous failed microfracture surgery in comparison with patients who had not been treated beforehand, especially when associated with a severe bone marrow lesion. [63][64][65] Postoperative MRI should show filling to the level of adjacent cartilage, with integration at the bone surface (►Fig.…”