Does the Choice of Acellular Scaffold and Augmentation With Bone Marrow Aspirate Concentrate Affect Short-term Outcomes in Cartilage Repair? A Systematic Review and Meta-analysis

Abstract

Background: Matrix-induced chondrogenesis (MIC) is a promising treatment option for critical-size cartilage lesions of the knee; however, there exists substantial heterogeneity in the choice of acellular scaffold matrix for MIC cartilage repairs. Hypothesis: The choice of acellular matrix will not affect patient outcomes after MIC cartilage repair procedures, and the addition of concentrated bone marrow aspirate (cBMA) will improve short-term patient outcomes regardless of matrix choice. Study Design: Meta-analysis; Level of evidence, 4. Methods: Studies were stratified by matrix type: multilayered, single layered, and gel based. Continuous outcomes were analyzed with pairwise meta-analysis using the inverse variance model with random effects applied. Binary outcomes were analyzed as pooled proportions in a single-arm fashion; after which, reconstruction of relative risks (RRs) with confidence intervals was performed using the Katz logarithmic method. Results: A total of 876 patients were included: 469 received multilayered bioscaffolds; 238, gel-based scaffolds; and 169, single-layered scaffolds. The mean age of patients was 36.2 years (95% CI, 33.9 to 38.4), while the mean lesion size was 3.91 cm2 (95% CI, 3.40 to 4.42). The weighted mean follow-up was 23.8 months (95% CI, 20.1 to 27.6). Multilayered bioscaffolds were most effective at improving visual analog scale scores ( P = .03; weighted mean difference [WMD], −4.44 [95% CI, −4.83 to −4.06]; P < .001). There were significantly lower risks of incomplete defect filling for gel-based scaffolds when compared with multilayered scaffolds (RR, 0.78 [95% CI, 0.69 to 0.88]; P < .001) and single-layered scaffolds (RR, 0.58 [95% CI, 0.41 to 0.81]; P = .001). Augmentation with cBMA further improved clinical scores across all scaffolds, with significant improvements in Tegner score ( P = .02), while decreasing incomplete defect filling rates as well. There was significantly greater improvement in visual analog scale scores ( P = .01) for single-layered scaffolds with cBMA augmentation (WMD, −4.88 [95% CI, −5.38 to −4.37]; P < .001) as compared with single-layered scaffolds without cBMA augmentation (WMD, −4.08 [95% CI, −4.46 to −3.71]; P < .001). All significant improvements were below their respective minimum clinically important differences. Conclusion: While cartilage repair with acellular scaffolds provides significant improvements in pain and function for patients, there is insufficient clinical evidence to suggest which scaffold material is the most superior in influencing such improvements. The enhancement of cartilage repair procedures with cBMA may provide further functional improvements and improve defect filling; however, more long-term evidence is required to evaluate the effects.

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“…Subgroup analysis demonstrated significantly greater Tegner scores (p = 0.02) and lower rates of incomplete defect filling in patients receiving bone marrow aspirate concentrate augmentation compared with those not receiving it. However, for all analyses, improvements were below their respective MCIDs 15 .…”

“…In a systematic review and meta-analysis of 33 studies with 876 patients, Ow et al 15 assessed short-term outcomes to compare the efficacy of different acellular scaffolds, with and without bone marrow aspirate concentrate for cartilage repair. Scaffolds were classified as single-layered (Hyalofast; Anika Therapeutics), multilayered (collagen I/III bilayer, Chondro-Gide; Geistlich Pharma), and gel-based, which included acellular collagen (Cartifill; Sewon Cellontech) and acellular chitosan (CarGel; Smith & Nephew).…”

Does intraoperative fluoroscopy improve acetabular component positioning and limb-length discrepancy during direct anterior total hip arthroplasty? A meta-analysis

“…We estimated the sample’s mean with the method presented by Luo et al [ 7 ] and the sample’s standard deviation (SD) based on the method presented by Wan et al [ 8 ] so that we could include these data in our meta-analysis. This method of estimating mean and standard deviation values has proven reliable [ 9 – 12 ].…”

Single-Stage Arthroscopic Cartilage Repair With Chondrectomy and Implantation of a Templated Membrane Collagen Scaffold With Bone Marrow Aspirate Concentrate Augmentation (AMIC Plus)

“…Chondro-Gide has been shown to provide the greatest degree of pain relief in short-term follow-up, with BMAC augmentation providing further improvement of outcomes. 1 Cartilage repair with Chondro-Gide traditionally has been performed through a mini-open approach through a parapatellar incision to allow for adequate lesion exposure, and templating and fixation of the acellular patch. However, in this article, we present our technique of an all-arthroscopic cartilage repair with the AMIC Plus procedure.…”