Particulated Juvenile Articular Cartilage and Matrix-Induced Autologous Chondrocyte Implantation Are Cost-Effective for Patellar Chondral Lesions

LeBrun, Drake G.; Nwachukwu, Benedict U.; Buza, Stephanie S.; Gruber, Simone; Marmor, William A.; Dennis, Elizabeth R.; Stein, Beth E. Shubin

doi:10.1016/j.arthro.2021.08.038

Cited by 7 publications

(5 citation statements)

References 45 publications

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“…Finally, the cost of MACI itself is worth mentioning given the estimate of approximately $40,000 29 for the graft itself and a total cost of care estimated at .$80,000 in the USbased population. 27 However, with these considerations taken into account, studies have demonstrated the overall cost-effectiveness of MACI as compared with nonoperative management 27,47 and microfracture. 31 Further long-term investigations of MACI outcomes as well as comparisons with developing 1-stage surgical alternatives 24,42 remain necessary.…”

Section: Discussionmentioning

confidence: 99%

Minimum 10-Year Outcomes of Matrix-Induced Autologous Chondrocyte Implantation in the Knee: A Systematic Review

Wang,

Nagelli,

Lamba

et al. 2024

Am J Sports Med

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Background: Matrix-induced autologous chondrocyte implantation (MACI) is an established cell-based therapy for the treatment of chondral defects of the knee. As long-term outcomes are now being reported in the literature, it is important to systematically review available evidence to better inform clinical practice. Purpose: To report (1) subjective patient-reported outcomes (PROs) and (2) the rate of graft failure, reoperation, and progression to total knee arthroplasty (TKA) after undergoing MACI of the knee at a minimum 10-year follow-up. Study Design: Systematic review; Level of evidence, 4. Methods: A comprehensive search of Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; and Scopus from 2008 to September 15, 2022, was conducted in the English language. Study eligibility criteria included (1) full-text articles in the English language, (2) patients undergoing a MACI within the knee, (3) clinical outcomes reported, and (4) a minimum 10-year follow-up. Results: In total, 168 patients (99 male, 69 female; mean age, 37 years [range, 15-63 years]; mean body mass index, 26.2 [range, 18.6-39.4]) representing 188 treated chondral defects at a minimum 10-year follow-up after MACI were included in this review. Significant and durable long-term improvements were observed across multiple PRO measures. Follow-up magnetic resonance imaging (MRI), when performed, also demonstrated satisfactory defect fill and an intact graft in the majority of patients. The all-cause reoperation rate was 9.0%, with an overall 7.4% rate of progression to TKA at 10 to 17 years of follow-up. Conclusion: At a minimum 10-year follow-up, patients undergoing MACI for knee chondral defects demonstrated significant and durable improvements in PROs, satisfactory defect fill on MRI-based assessment, and low rates of reoperation and TKA. These data support the use of MACI as a long-term treatment of focal cartilage defects of the knee.

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Section: Discussionmentioning

confidence: 99%

Minimum 10-Year Outcomes of Matrix-Induced Autologous Chondrocyte Implantation in the Knee: A Systematic Review

Wang,

Nagelli,

Lamba

et al. 2024

Am J Sports Med

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“…Unlike MACI, only a single procedure is necessary for PJAC, decreasing the theoretical risk of knee morbidity and overall cost. 24 Moreover, in cases where the subchondral bone of the patella is not also compromised, PJAC provides a less invasive technique that can be molded to the patient-specific anatomy compared with alternative options that inherently include the bone, such as OCA and can be challenging to match the topography of the patella. To date, no alternative cartilage restoration technique has demonstrated superior clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike cell-based methods—such as matrix-induced autologous chondrocyte implantation (MACI)—PJAC is a single-stage technique, potentially adding the benefit of decreased morbidity and cost. 24 Several studies have reported promising results in short-term patient outcomes. 5 , 37 , 38 High fill rates and evidence of matured grafts with hyaline-like cartilage have also been reported.…”

mentioning

confidence: 99%

Outcomes of Particulated Juvenile Articular Cartilage and Association With Defect Fill in Patients With Full-Thickness Patellar Chondral Lesions

Marmor,

Dennis,

Buza

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Cartilage restoration procedures for patellar cartilage defects have produced inconsistent results, and optimal management remains controversial. Particulated juvenile articular cartilage (PJAC) allograft tissue is an increasingly utilized treatment option for chondral defects, with previous studies demonstrating favorable short-term outcomes for patellar chondral defects. Purpose: To identify whether there is an association between defect fill on magnetic resonance imaging (MRI) with functional outcomes in patients with full-thickness patellar cartilage lesions treated with PJAC. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of prospectively collected data was conducted on patients treated with PJAC for a full-thickness symptomatic patellar cartilage lesion between March 2014 and August 2019. MRI was performed for all patients at 6, 12, and 24 months postoperatively. Patient-reported outcome measures (PROMs) were obtained preoperatively and at 1, 2, and >2 years postoperatively. Clinical outcome scores—including the International Knee Documentation Committee (IKDC) score, the Kujala, the Knee injury and Osteoarthritis Outcome Score–Physical Function Short Form (KOOS-PS), the Knee Injury and Osteoarthritis Outcome Score–Quality of Life (KOOS-QoL), and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS)—were analyzed and evaluated for a relationship with tissue fill on MRI. Results: A total of 70 knees in 65 patients (mean age, 26.6 ± 8.1 years) were identified, of which 68 knees (97%) underwent a concomitant patellar stabilization or offloading procedure. Significant improvements were observed on all postoperative PROM scores at the 1-, 2-, and >2-year follow-up except for the Pedi-FABS, which showed no significant difference from baseline. From baseline to the 2-year follow-up, the KOOS-QoL improved from 24.7 to 62.1, the IKDC improved from 41.1 to 73.5, the KOOS-PS improved from 35.6 to 15, and the Kujala improved from 52 to 86.3. Imaging demonstrated no difference in the rate of cartilage defect fill between the 3-month (66%), 6-month (72%), 1-year (74%), and ≥2-year (69%) follow-ups. No association was observed between PROM scores and the percent fill of cartilage defect on MRI at the 1- and 2-year follow-up. Conclusion: PROM scores were significantly improved at the 2-year follow-up in patients who underwent PJAC for full-thickness patellar cartilage defects. On MRI, a cartilage defect fill of >66% was achieved by 3 months in most patients. In our sample, PROM scores were not significantly associated with the defect fill percentage at the short-term follow-up.

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“…In a cost analysis model, LeBrun et al. 18 determined that MACI added 6.92 quality-adjusted life-years although at a cost of $83,073 owing to the 2-stage nature and expense of the graft. Vogelmann et al., 5 however, developed a discrete-event simulation of over 10,000 patients in the German health care system with an average chondral defect size of 4.5 cm 2 .…”

Section: Discussionmentioning

confidence: 99%

Cartilage Biopsy for Autologous Cell–Based Repair of the Knee in the Wide-Awake Setting Using Needle Arthroscopy

Savage-Elliott,

Kingery,

Azam

et al. 2023

Arthroscopy Techniques

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Particulated Juvenile Articular Cartilage and Matrix-Induced Autologous Chondrocyte Implantation Are Cost-Effective for Patellar Chondral Lesions

Cited by 7 publications

References 45 publications

Minimum 10-Year Outcomes of Matrix-Induced Autologous Chondrocyte Implantation in the Knee: A Systematic Review

Minimum 10-Year Outcomes of Matrix-Induced Autologous Chondrocyte Implantation in the Knee: A Systematic Review

Outcomes of Particulated Juvenile Articular Cartilage and Association With Defect Fill in Patients With Full-Thickness Patellar Chondral Lesions

Cartilage Biopsy for Autologous Cell–Based Repair of the Knee in the Wide-Awake Setting Using Needle Arthroscopy

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