Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes

Gobbi, Alberto; Karnatzikos, Georgios; Kumar, Ashok

doi:10.1007/s00167-013-2676-8

Cited by 260 publications

(194 citation statements)

References 39 publications

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“…Gobbi et al, 127 in a series of 61 patients followed for 15 years, reported good results at short-term follow-up, but that deterioration could be expected after 2-5 years. Their failure rate, defined as need for reoperation, was only 7 patients (11%), but 40% showed osteoarthritic changes.…”

Section: Results Of Microfracturementioning

confidence: 97%

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

Mistry

Connock

Pink

et al. 2017

Health Technol Assess

190

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: Results Of Microfracturementioning

confidence: 97%

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

Mistry

Connock

Pink

et al. 2017

Health Technol Assess

190

164

View full text Add to dashboard Cite

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“…Although the structural [78] and functional [79] clinical results of marrow stimulation are usually good, the fibrocartilaginous repair tissue is inferior to the original hyaline cartilage. Possibly, application of novel insights to the problem of fibrosis with its excess deposition of an inferior fibrous tissue may show new avenues towards the goal of achieving true hyaline articular cartilage regeneration.…”

Section: Discussionmentioning

confidence: 99%

Bone Marrow Aspirate Concentrate-Enhanced Marrow Stimulation of Chondral Defects

Madry

Eichler

Orth

et al. 2017

Stem Cells International

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Mesenchymal stem cells (MSCs) from bone marrow play a critical role in osteochondral repair. A bone marrow clot forms within the cartilage defect either as a result of marrow stimulation or during the course of the spontaneous repair of osteochondral defects. Mobilized pluripotent MSCs from the subchondral bone migrate into the defect filled with the clot, differentiate into chondrocytes and osteoblasts, and form a repair tissue over time. The additional application of a bone marrow aspirate (BMA) to the procedure of marrow stimulation is thought to enhance cartilage repair as it may provide both an additional cell population capable of chondrogenesis and a source of growth factors stimulating cartilage repair. Moreover, the BMA clot provides a three-dimensional environment, possibly further supporting chondrogenesis and protecting the subchondral bone from structural alterations. The purpose of this review is to bridge the gap in our understanding between the basic science knowledge on MSCs and BMA and the clinical and technical aspects of marrow stimulation-based cartilage repair by examining available data on the role and mechanisms of MSCs and BMA in osteochondral repair. Implications of findings from both translational and clinical studies using BMA concentrate-enhanced marrow stimulation are discussed.

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“…Microfracturing is known to be a cost effective first-line treatment option that leads to good results in the short-term but cartilage repair deteriorates in the mid to long-term [14,15]. Two-step procedures such as autologous chondrocyte implantation (ACI) have been shown to be clinically effective.…”

Section: Discussionmentioning

confidence: 99%

“…A blood clot forms and in-growth of progenitor cells occurs with subsequent formation of a fibrous to fibro-cartilage-like repair tissue [12,13]. However, clinical studies showed that the procedure is effective in the short-term but the clinical outcome may deteriorate in the mid-to long-term and may lead to degeneration [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Repair of retropatellar cartilage defects in the knee with microfracture and a cell-free polymer-based implant

Becher

Ettinger

Ezechieli

et al. 2015

Arch Orthop Trauma Surg

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Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes

Abstract: IV.

Cited by 260 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

Bone Marrow Aspirate Concentrate-Enhanced Marrow Stimulation of Chondral Defects

Repair of retropatellar cartilage defects in the knee with microfracture and a cell-free polymer-based implant

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