Ten-Year Follow-up of a Prospective, Randomized Clinical Study of Mosaic Osteochondral Autologous Transplantation Versus Microfracture for the Treatment of Osteochondral Defects in the Knee Joint of Athletes

Gudas, Rimtautas; Gudaitė, Agnė; Pocius, Arnoldas; Gudiene, Asta; Čekanauskas, Emilis; Monastyreckienė, Eglė; Basevičius, Algidas

doi:10.1177/0363546512458763

Cited by 324 publications

(262 citation statements)

References 27 publications

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“…Gudas et al 128 reported outcomes in the MF arm of a trial against mosaicplasty. In 29 patients, 11 (34%) had failed (required reoperation) by 10 years.…”

Section: Results Of Microfracturementioning

confidence: 99%

“…It should be emphasised that uncertainty in these comparisons is substantial, especially with regard to the Knutsen Years FIGURE 11 Modelled failure in MF studies compared with worst-performing subgroups from Nawaz et al 80 ACI study. 128 -excluded on the basis of its small size -showed that the best fit for the reconstructed IPD was a log-normal model, which predicted poorer survival than the models for MF for the Layton, 114 Knutsen 67 and Saris 70 studies.…”

Section: Figure 10mentioning

confidence: 93%

“…78 (N = 100 with about 10 years of follow-up) compared ACI with mosaicplasty -we are interested only in the ACI arm and these patients were included in the larger study of Nawaz et al 80 and so are not considered further. The RCT of Gudas et al 128 compared MF with mosaicplasty but did not satisfy inclusion criteria. Figure 1 summarises the reconstructed time-to-failure KM plots for the Knutsen et al 67 and Vanlauwe et al 43 RCTs, which extended to 5 and 6 years of follow-up, respectively.…”

Section: Description Of Time-to-failure Datamentioning

confidence: 99%

“…Graphs-of-model fits for included studies that are most relevant to the decision problem are presented, arranged by study in alphabetical order. Other appendices provide model information for the MF study of Bae et al, 134 Gudas et al 128 and the unpublished ACTIVE trial.…”

Section: Web Of Science Core Collection 2010 To June 2014mentioning

confidence: 99%

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Autologous chondrocyte implantation in the knee: systematic review and economic evaluation

Mistry

Connock

Pink

et al. 2017

Health Technol Assess

213

164

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BackgroundThe surfaces of the bones in the knee are covered with articular cartilage, a rubber-like substance that is very smooth, allowing frictionless movement in the joint and acting as a shock absorber. The cells that form the cartilage are called chondrocytes. Natural cartilage is called hyaline cartilage. Articular cartilage has very little capacity for self-repair, so damage may be permanent. Various methods have been used to try to repair cartilage. Autologous chondrocyte implantation (ACI) involves laboratory culture of cartilage-producing cells from the knee and then implanting them into the chondral defect.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of ACI in chondral defects in the knee, compared with microfracture (MF).Data sourcesA broad search was done in MEDLINE, EMBASE, The Cochrane Library, NHS Economic Evaluation Database and Web of Science, for studies published since the last Health Technology Assessment review.Review methodsSystematic review of recent reviews, trials, long-term observational studies and economic evaluations of the use of ACI and MF for repairing symptomatic articular cartilage defects of the knee. A new economic model was constructed. Submissions from two manufacturers and the ACTIVE (Autologous Chondrocyte Transplantation/Implantation Versus Existing Treatment) trial group were reviewed. Survival analysis was based on long-term observational studies.ResultsFour randomised controlled trials (RCTs) published since the last appraisal provided evidence on the efficacy of ACI. The SUMMIT (Superiority of Matrix-induced autologous chondrocyte implant versus Microfracture for Treatment of symptomatic articular cartilage defects) trial compared matrix-applied chondrocyte implantation (MACI®) against MF. The TIG/ACT/01/2000 (TIG/ACT) trial compared ACI with characterised chondrocytes against MF. The ACTIVE trial compared several forms of ACI against standard treatments, mainly MF. In the SUMMIT trial, improvements in knee injury and osteoarthritis outcome scores (KOOSs), and the proportion of responders, were greater in the MACI group than in the MF group. In the TIG/ACT trial there was improvement in the KOOS at 60 months, but no difference between ACI and MF overall. Patients with onset of symptoms < 3 years’ duration did better with ACI. Results from ACTIVE have not yet been published. Survival analysis suggests that long-term results are better with ACI than with MF. Economic modelling suggested that ACI was cost-effective compared with MF across a range of scenarios.LimitationsThe main limitation is the lack of RCT data beyond 5 years of follow-up. A second is that the techniques of ACI are evolving, so long-term data come from trials using forms of ACI that are now superseded. In the modelling, we therefore assumed that durability of cartilage repair as seen in studies of older forms of ACI could be applied in modelling of newer forms. A third is that the high list prices of chondrocytes are reduced by confidential discounting. The main research needs are for longer-term follow-up and for trials of the next generation of ACI.ConclusionsThe evidence base for ACI has improved since the last appraisal by the National Institute for Health and Care Excellence. In most analyses, the incremental cost-effectiveness ratios for ACI compared with MF appear to be within a range usually considered acceptable. Research is needed into long-term results of new forms of ACI.Study registrationThis study is registered as PROSPERO CRD42014013083.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Gudas et al 128 reported outcomes in the MF arm of a trial against mosaicplasty. In 29 patients, 11 (34%) had failed (required reoperation) by 10 years.…”

Section: Results Of Microfracturementioning

confidence: 99%

Section: Figure 10mentioning

confidence: 93%

Section: Description Of Time-to-failure Datamentioning

confidence: 99%

Section: Web Of Science Core Collection 2010 To June 2014mentioning

confidence: 99%

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Autologous chondrocyte implantation in the knee: systematic review and economic evaluation

Mistry

Connock

Pink

et al. 2017

Health Technol Assess

213

164

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show abstract

“…Recent 10 year follow-up study showed superior clinical results of osteochondral grafting compared with microfracture in young athletes with focal osteochondral defects [17]. An earlier clinical study of ACI showed an improvement in symptoms in 14 out of 16 patients at 2 years who had femoral condylar lesions [18].…”

Section: Introductionmentioning

confidence: 99%

Bioengineering of Articular Cartilage: Past, Present and Future

Felimban

Moulton

et al. 2013

Regen. Med.

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The treatment of cartilage defects poses a clinical challenge owing to the lack of intrinsic regenerative capacity of cartilage. The use of tissue engineering techniques to bioengineer articular cartilage is promising and may hold the key to the successful regeneration of cartilage tissue. Natural and synthetic biomaterials have been used to recreate the microarchitecture of articular cartilage through multilayered biomimetic scaffolds. Acellular scaffolds preserve the microarchitecture of articular cartilage through a process of decellularization of biological tissue. Although promising, this technique often results in poor biomechanical strength of the graft. However, biomechanical strength could be improved if biomaterials could be incorporated back into the decellularized tissue to overcome this limitation.

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Surgical interventions (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults

Gracitelli

Moraes

Franciozi

et al. 2016

Cochrane Database of Systematic Reviews

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Ten-Year Follow-up of a Prospective, Randomized Clinical Study of Mosaic Osteochondral Autologous Transplantation Versus Microfracture for the Treatment of Osteochondral Defects in the Knee Joint of Athletes

Abstract: The OAT technique for ACD or OCD repair in the athletic population allows for a higher rate of return to and maintenance of sports at the preinjury level compared with MF.

Cited by 324 publications

References 27 publications

Autologous chondrocyte implantation in the knee: systematic review and economic evaluation

Autologous chondrocyte implantation in the knee: systematic review and economic evaluation

Bioengineering of Articular Cartilage: Past, Present and Future

Surgical interventions (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults

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