The surgical management of symptomatic articular cartilage defects of the knee: Consensus statements from United Kingdom knee surgeons

Biant, Leela; McNicholas, Michael; Sprowson, Andrew P.; Spalding, T. J. W.

doi:10.1016/j.knee.2015.06.001

Cited by 54 publications

(41 citation statements)

References 39 publications

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“…39 BOX 2 National Institute for Health and Care Excellence Guidance. Reproduced with permission from NICE 34 Guidance 1.1 Current evidence suggests that there are no major safety concerns associated with mosaicplasty for knee cartilage defects.…”

Section: Conservative Managementmentioning

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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Section: Conservative Managementmentioning

confidence: 99%

“…The BASK UK 39 Consensus recommends that patients should have conservative treatment with physical therapy before being considered for cartilage repair. Many will become asymptomatic and will no longer qualify for ACI according to the NICE scope.…”

Section: Asymptomatic Lesionsmentioning

confidence: 99%

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

Mistry

Connock

Pink

et al. 2017

Health Technol Assess

213

164

View full text Add to dashboard Cite

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“…Micro fracture technique is routine practice within the NHS [41] but this procedure was not indicated over other ACR approaches in this study. he issues of knowledge transfer and lack of expedient adoption of research indings into practice are implicated to some extent [42]; over 25 years of research data detail the ACR procedures in question [43] yet these surgical options had lowest reported representation across all professions.…”

Section: Final Awarded Qualiicationmentioning

confidence: 99%

“…here is recognition that generic rehabilitation principles may be limited [44] and recommendations suggest that speciic and targeted rehabilitation has not been suiciently explored [43]. ACR has potential requirement for specialist physical therapy dependent on the individual patient and approach used [45].…”

Section: Final Awarded Qualiicationmentioning

confidence: 99%

Exploring Cross-Curriculum Content of Undergraduate Musculoskeletal Therapy Courses Regarding Articular Cartilage; Implications of Surveying UK Healthcare Curriculum Providers

Bright¹

2016

J Musculoskelet Disord Treat

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“…Die "Arbeitsgemeinschaft (AG) für klinische Geweberegeneration" der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) publizierte im Jahr 2004 ein erstes Positionspapier zur Indikation und Anwendung der autologen Chondrozytentransplantation (ACT) im Kniegelenk [1]. Während die Empfehlungen von damals noch überwiegend auf den klinischen Erfahrungen der AG-Mitglieder basierten, wurden sie in den folgenden Jahren durch die Ergebnisse klinischer Studien im Grundsatz bestätigt, in 2016 letztmals der bestverfügbaren Evidenz angepasst [2] und in ähnlicher Form auch von anderen Autoren und Fachorganisationen übernommen [2][3][4]. Im Gegensatz zum Knie-oder auch Sprunggelenk [5] existieren von der AG und dem Hüftkomitee ZUSAMMENFASSUNG Hintergrund Symptomatisch präarthrotische Deformitäten wie das femoroazetabuläre Impingement (FAI) oder die Hüftdysplasie führen häufig zu lokalisierten Knorpeldefekten und nachfolgend zur Entstehung einer Koxarthrose.…”

Section: Introductionunclassified

Biologische Rekonstruktion lokalisiert vollschichtiger Knorpelschäden des Hüftgelenks: Empfehlungen der Arbeitsgemeinschaft „Klinische Geweberegeneration“ der DGOU und des Hüftkomitees der AGA

et al. 2017

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Symptomatic pre-arthritic deformities such as femoroacetabular impingement (FAI) or hip dysplasia often lead to localised cartilage defects and subsequently to osteoarthritis. The present review of the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Trauma (DGOU) and the hip committee of the AGA (German speaking Society for Arthroscopy and Joint Surgery) provides an overview of current knowledge of the diagnosis and surgical treatment of cartilage defects, in order to infer appropriate therapy recommendations for the hip. Review of FAI and resultant cartilage damage in the hip as reported in published study findings in the literature and discussion of the advantages and disadvantages of different surgical procedures to preserve the joint. Most published studies on the surgical treatment of cartilage damage in the hip report defects caused by cam-type FAI at the acetabulum. Development of these defects can be prevented by timely elimination of the relevant deformities. At present, current full-thickness cartilage defects are mostly treated with bone marrow-stimulating techniques such as microfracture (MFx), with or without a biomaterial, and matrix-assisted autologous chondrocyte transplantation (MACT). Osteochondral autologous transplantation (OAT) is not the treatment of choice for isolated full-thickness chondral defects at the hip, because of the unfavourable risk-benefit profile. Due to the relatively short history of cartilage repair surgery on the hip, the studies available on these procedures have low levels of evidence. However, it is already becoming obvious that the experience gained with the same procedures on the knee can be applied to the hip as well. For example, limited healing and regeneration of chondral defects after MFx can also be observed at the hip joint. The cartilage surface of the acetabulum, where FAI-related chondral lesions appear, is considerably smaller than the weight-bearing cartilage surface of the knee joint. However, as in the knee joint, MACT is the therapy of choice for full-thickness cartilage defects of more than 1.5 - 2 cm. Minimally invasive types of MACT (e.g. injectable chondrocyte implants) should be preferred in the hip joint. In cases where a single-stage procedure is indicated or there are other compelling reasons for not performing a MACT, a bone marrow-stimulating technique in combination with a biomaterial covering is preferable to standard MFx. For treatment of lesions smaller than 1.5 - 2 cm the indication for a single-stage procedure is wider. As with defects in the knee, it is not possible to determine a definite upper age limit for joint-preserving surgery or MACT in the hip, as the chronological age of patients does not necessarily correlate with their biological age or the condition of their joints. Advanced osteoarthritis of the hip is a contraindication for any kind of hip-preserving surgery. Long-term observations and prospective randomised studies like those carried out for other joints are necessary.

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The surgical management of symptomatic articular cartilage defects of the knee: Consensus statements from United Kingdom knee surgeons

Cited by 54 publications

References 39 publications

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

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

Exploring Cross-Curriculum Content of Undergraduate Musculoskeletal Therapy Courses Regarding Articular Cartilage; Implications of Surveying UK Healthcare Curriculum Providers

Biologische Rekonstruktion lokalisiert vollschichtiger Knorpelschäden des Hüftgelenks: Empfehlungen der Arbeitsgemeinschaft „Klinische Geweberegeneration“ der DGOU und des Hüftkomitees der AGA

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