Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture: Five-Year Follow-up of a Prospective Randomized Trial

Abstract

Symptomatic cartilage knee defects 3 cm or larger treated with MACI were clinically and statistically significantly improved at 5 years compared with microfracture treatment. No remarkable adverse events or safety issues were noted in this heterogeneous patient population.

Autologous Chondrocyte Implantation Versus Microfracture in the Knee: A Meta-analysis and Systematic Review

“…A final group of 12 RCTs that met the eligibility criteria were included in the meta-analysis and systematic review. 5,6,8,[16][17][18][19][20][21][22][23][24] The 12 final selected studies enrolled a total of 659 patients with knee cartilage lesions; 332 of these patients had received ACI and 327 patients had undergone MF treatment. The characteristics of the 12 studies are summarized in Table 1.…”

“…The diverse types of ACI performed among the eligible studies included matrix-induced autologous chondrocyte implantation (MACI), 16,19,21 NeoCart (an autologous cartilage tissueeengineered implant; Histogenics Corp, Waltham, MA), 17 ACI with periosteum, 5,6,8,24 and ChondroCelect (Tigenix NV, Brussels, Belgium). 18,20,22,23 ChondroCelect was withdrawn from the market for commercial reasons in 2016 (http://www.ema.europa.eu/docs/enGB/document_ library/Public_statement/2016/08/WC500211564.pdf).…”

Repair of Damaged Articular Cartilage: Current Approaches and Future Directions

“…The treatment of larger lesions (>4.5 cm 2 ) with regenerative approaches (i.e., ACI/MACI) produces more favorable outcomes than with a microfracture [46,47], which is most commonly used at present. However, no current repair therapy re-creates native hyaline cartilage and provides long-term restoration [33,195], due mainly to the formation of fibrocartilage and/or poor matrix properties.…”

“…Subsequently, in second-generation ACI, biodegradable collagen membranes replace the periosteal patch [43,44], avoiding the invasiveness of periosteal harvesting and the extensive chondrocyte hypertrophy that sometimes occurs in association with the periosteum [45]. Compared to microfracture or mosaic chondroplasty, ACI allows repairs of larger cartilage defects [46,47]. The main limitations to this approach include its high cost [48,49], as well as the invasiveness of harvesting, and, in particular, the formation of fibrocartilage, which often occurs due to the de-differentiation of chondrocytes during cell expansion [44].…”

“…This procedure involves transplantation of a special three-dimensional scaffold comprised of autologous chondrocytes (expanded previously) into the cartilage defect. During the first two years after surgery, satisfactory results were obtained with both MACI and microfracture, but an improvement with MACI was significantly better five years post-surgery [47]. …”