Collagen-Covered Autologous Chondrocyte Implantation Versus Autologous Matrix-Induced Chondrogenesis: A Randomized Trial Comparing 2 Methods for Repair of Cartilage Defects of the Knee

Abstract

Background:Autologous matrix-induced chondrogenesis (AMIC) is a single-stage alternative to autologous chondrocyte implantation for treatment of localized cartilage defects of the knee. To our knowledge, no randomized controlled trial exists comparing the 2 methods.Purpose:To evaluate any difference in the outcome of AMIC as compared with collagen-covered autologous chondrocyte implantation (ACI-C).Study Design:Randomized controlled trial; Level of evidence, 2.Methods:A prospective randomized controlled clinical trial was designed to assess any differences in the outcomes between ACI-C and AMIC for the treatment of ≥1 chondral or osteochondral defects of the distal femur and/or patella. The inclusion period was set to 3 years, and the aim was to include 80 patients (40 in each group). Patient inclusion was broad, with few exclusion criteria. The primary outcome was change in Knee injury and Osteoarthritis Outcome Score (KOOS) at 2 years as compared with baseline. The secondary outcomes were the number of failures in each group at 2 years and the change in KOOS subscale, Lysholm, and pain visual analog scale (VAS) scores at 2 years as compared with baseline. A 2-sample t test with a significance level of P < .05 was used to compare the change in score from baseline between groups.Results:A total of 41 patients over 3 years were included in the study: 21 in the ACI-C group and 20 in the AMIC group. All the patients had prior surgery to the index knee. At 2-year follow-up, the clinical scores for both groups improved significantly from baseline. No significant differences between groups were seen in the change from baseline for KOOS (AMIC, 18.1; ACI-C, 10.3), any of the KOOS subscales, the Lysholm score (AMIC, 19.7; ACI-C, 17.0), or the VAS pain score (AMIC, 30.6; ACI-C, 19.6). Two patients in the AMIC group had progressed to a total knee replacement by the 2-year follow-up as compared with none in the ACI-C group.Conclusion:At 2-year follow-up, no significant differences were found regarding outcomes between ACI-C and AMIC. Mid- and long-term results will be important.Registration:NCT01458782 ( ClinicalTrials.gov identifier).

Autologous Matrix-Induced Chondrogenesis for Treatment of Focal Cartilage Defects in the Knee: A Follow-up Study

“…Specific to ACI in comparison with AMIC, both procedures show comparable outcomes. 10 Although this was a fairly small study, with only 21 ACI patients and 20 AMIC patients, it seems that either treatment can achieve positive outcomes for patients.…”

“…Some of these were previously mentioned by Gao et al, 12 who pointed to the need for further high-level studies. Although the recent data that were presented by Fossum et al 10 would certainly meet the criteria for a level 1 study, the use of data from a registry such as ours should not be discounted. The use of a registry provides real-world data among a diverse patient population, although this limits data collection because follow-up visits adhere to standard of care, whereas prospective studies will have predefined data collection points.…”

Biosafety evaluation of culture-expanded human chondrocytes with growth factor cocktail: a preclinical study

“…Adult cartilage has a limited regenerative capability due to its unique structure as it is avascular, aneural, and alymphatic 1 . Autologous chondrocyte implantation (ACI) and matrix-assisted autologous chondrocyte implantation (M-ACI) are the most promising cell-based treatments to treat cartilage defects 2 – 4 . In both procedures, chondrocytes are retrieved from patients’ own cartilage, serially expanded in vitro, and re-implanted into the patients’ defective site 2 , 5 .…”

Nonoperative and Operative Soft-Tissue and Cartilage Regeneration and Orthopaedic Biologics of the Knee: An Orthoregeneration Network (ON) Foundation Review

“…The use of matrix cellebased cell therapy was reported by Brittberg et al 58 to result in superior outcomes at 5-year follow-up compared with patients undergoing microfracture alone for symptomatic cartilage knee defects !3 cm 2 . Moreover, Fossum et al 59 reported significant improvements in clinical outcomes at 2 years in patients with symptomatic chondral or osteochondral defects (>2 cm 2 ) of the distal femur or patella treated with autologous matrix-induced chondrogenesis (AMICÒ) or collagen-covered autologous chondrocyte implantation (ACI-C). Volz et al 60 reported significant functional improvement at 5 years in patients with isolated cartilage defects (2 to 3 cm 2 ) of the knee located on the medial or lateral femoral condyle, trochlea, or patella treated with AMIC using a type I/III collagen membrane compared with microfracture alone.…”