Purpose Articular resurfacing by treatment of chondral defects may include chondral abrasion, autologous chondrocyte Implantation (ACI), matrix‐induced chondrocyte transplantation (MACT) or osteochondral autologous transplantation (OATS). This technical note describes the method of autologous matrix‐induced chondrogenesis (AMIC), a one‐step procedure combining subchondral microfracture with the fixation of a collagen I/III membrane with fibrin glue or sutures. Methods This is a technical note on the AMIC procedure and its further development. Results and conclusion This method is applied primarily in chondral or osteochondral lesions of the knee. Indications and contraindications are provided; the technique is described. The further development of AMIC is described with an increased focus on the subchondral zone and the complex of cartilage and bone, the osteochondral unit, which receives increased attention in cartilage research. Level of evidence IV.
Options for the treatment of cartilage defects include chondral resurfacing with abrasion, debridement, autologous chondrocyte transplantation (ACT), matrix-induced chondrocyte transplantation (MACI), or osteochondral autologous transplantation (OATS). This article describes the new method of autologous matrix-induced chondrogenesis (AMIC), a 1-step procedure combining subchondral microfracture with the fixation of a collagen I/III membrane by a partially autologous fibrin glue. Indications and contraindications are provided; a technical note is given. This method is primarily applied in osteochondral lesions of the knee and ankle joints; other joints may qualify.
Purpose The aim of this study was to perform a systematic review of studies concerning current treatment of chondral defects of the knee. Methods The relevance for evidence based data and for successful surgical treatment of cartilage defects was evaluated. From 56,098 evaluated studies, 133 studies could be further pursued. These supplied data concerning microfracturing, the osteochondral autograft transplantation system (OATS), the autologous chondrocyte implantation (ACI) and the matrix induced chondrocyte implantation (MACI). The modified Coleman Methodical Score (CMS) and the Level of Evidence (LOE) were applied to evaluate the quality. Results In these studies, a total of 6,920 patients were reviewed with a median of 32 patients per study and a mean follow-up of 24 months. The mean CMS was 58 of 100 points. No study reached 100 points in the CMS. Three studies reached a level above 90. Ten studies were Level I, five studies reached Level II. Seven studies reached Level III, 111 studies Level IV. MRI scans to verify the clinical data were used by only 72 studies. The means in the modified CMS were for the different procedures as follows: ACI 58 points, MACI 57 points, microfracturing 68 points and OATS 50 points. 24 studies applied the Lysholm Score (LS) for clinical evaluation of cartilage surgery. All operative procedures yielded comparable improvements of the LS (n.s.) meaning that no operative procedure proved superior. Conclusion As the majority of studies evaluated by this review is insufficient for EBM purposes more coherent studies with LOE of I or II are needed. Co-relating the systems of CMS and LOE and validating the applied scores seems desirable.
The authors suggest a new method for a standardised procedure using a new perforating device. Advances in MSS by subchondral bone marrow perforation are discussed. It remains to be determined by clinical studies how this method compares to microfracturing. The subchondral needling offers the surgeon and the investigator a method that facilitates comparison studies because of its defined depth of subchondral penetration and needle size.
Objective This study is a literature review from 2010 to 2014 concerning the quality of evidence in clinical trials about microfracture in attempt to repair articular cartilage. We have decided to focus on microfracturing, since this seems to be the best documented technique. Interest in evaluation of publication quality has risen in orthopaedic sports medicine recently. Therefore, we think it is necessary to evaluate recent clinical trials being rated for their evidence-based medicine (EBM) quality. We also compared the mean impact factor of the journals publishing the different studies as an indicator of the study's citation and evaluated for a change over the studied time frame. Design To measure the EBM level, we applied the modified Coleman Methodology Score (CMS) introduced by Jakobsen. The impact factor, which is a measurement of the yearly average number of citations of articles recently published in that journal, was evaluated according to self-reported values on the corresponding journal's website. Results We found that the mean CMS has not changed between 2010 and 2014. The mean impact factor has also not changed between 2010 and 2014. The CMS variance was high, pointing to different qualities in the evaluated studies. There is no evidence that microfracturing is superior compared to other cartilage repair procedures. Conclusion Microfracture cannot be seen as an evidence based procedure. Further research needs to be done and a standardization of the operating method is desirable. There need to be more substantial studies on microfracturing alone without additional therapies.
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