Matrix-Associated Chondrocyte Implantation Is Associated With Fewer Reoperations Than Microfracture: Results of a Population-Representative, Matched-Pair Claims Data Analysis for Cartilage Defects of the Knee

Abstract

Background:Symptomatic cartilage defects of the knee are commonly surgically treated by microfracture (MFX) or matrix-associated chondrocyte implantation (M-ACI). Several randomized controlled trials have compared MFX and M-ACI, showing a tendency to lower reoperation rates for M-ACI, but results vary widely between studies.Purpose:To compare reoperation rates after MFX and M-ACI in cartilage defects of the knee outside clinical trials in a representative sample of the population.Study Design:Cohort study; Level of evidence, 3.Methods:This study was based on anonymized, population-representative claims data of 4 million insured persons in Germany. Patients who underwent MFX or M-ACI for cartilage defects of the knee with a follow-up of 2 years were compared. The primary endpoint was the need for a reoperation, defined as a claim for a second surgical procedure from the same patient at the knee joint (27 procedure codes), meniscus and cartilage (35 procedure codes), or patella (102 procedure codes) or the need for knee replacement (11 procedure codes). Group comparisons were performed using log-rank tests, with a 2-sided P value of <.05 to indicate significance. For adjusted analysis, propensity score matching was applied. Age, sex, comedications, and comorbidities were used as matching parameters.Results:A total of 6425 patients fulfilled the inclusion criteria: 6273 treated with MFX and 152 treated with M-ACI (mean age, 53 and 36 years, respectively). In the 2 years after treatment, 1271 patients in the MFX group needed a reoperation compared with 19 in the M-ACI group (20.3% vs 12.5%, respectively; P = .0199). For adjusted analysis after propensity score matching, 127 patients per group were analyzed. Their mean age was 37 years. At the end of the second follow-up year, 28 and 16 patients needed reoperations in the MFX and M-ACI groups, respectively (22.0% vs 12.6%, respectively; P = .0498).Conclusion:This study used a representative sample of the population and a broad definition of a reoperation, thus expanding evidence from clinical trials. We found a significant advantage of M-ACI in reoperation rates 2 years after treatment. After adjusting for age, sex, comedications, and comorbidities, M-ACI still showed significantly lower reoperation rates after 2 years.

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

“…The lower treatment failure rate for ACI compared with MF is in accordance with a recently published population representative matched-pair claims data analysis showing a 20.3% rate of reoperation after MF versus 12.5% after ACI ( P = 0.0199). 38…”

Incidence, Prevalence, and Real-World Treatment Patterns in Chronic Myeloid Leukemia: Results from a Population-Representative German Claims Data Analysis

“…This population-based observational cohort study was based on the InGef research database. The InGef research database (formerly: Heath Risk Institute) is an anonymized German health claims database comprising longitudinal data from over 6 million people insured in one of 70 statutory German health insurances contributing data to the database [9, 10]. For the purpose of this analysis, the dataset was adjusted by age and sex to match the demographic structure of the German population and condensed to a sample of 4,275,226 people covered by SHI from January 1, 2012, to December 31, 2017 [11].…”

Effect of Mechanical Mincing on Minimally Manipulated Articular Cartilage for Surgical Transplantation

“…However, microfracture produces varied clinical outcomes secondary to the unsatisfactory mechanical durability of resultant fibrocartilage repair tissue. 11,29,41,42,48 Osteochondral autograft transplantation is resource intensive, technically challenging, and associated with donor-site morbidity, while OCA transplantation outcomes have been complicated by increased failure rates requiring a reoperation or revision arthroplasty. [5][6][7]13,19,23,32,49 Recent advances in tissue engineering have led to cellular-based therapies, such as autologous chondrocyte implantation, with the goal of replacing larger (4 cm 2 ) cartilage defects with tissue comparable with native hyaline cartilage.…”

“…However, microfracture produces varied clinical outcomes secondary to the unsatisfactory mechanical durability of resultant fibrocartilage repair tissue. 11,29,41,42,48 Osteochondral autograft transplantation is resource intensive, technically challenging, and associated with donor-site morbidity, while OCA transplantation outcomes have been complicated by increased failure rates requiring a reoperation or revision arthroplasty. 5-7,13,19,23,32,49…”