Matrix-Assisted Autologous Chondrocyte Transplantation in the Knee: A Systematic Review of Mid- to Long-Term Clinical Outcomes

Abstract

Background:Matrix-assisted autologous chondrocyte transplantation (MACT) is a surgical treatment option for articular cartilage lesions of the knee joint.Purpose:To investigate mid- to long-term clinical outcomes of MACT in the patellofemoral (PF) and tibiofemoral (TF) joints.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review was performed by searching PubMed, Embase, and the Cochrane Library to find studies evaluating minimum 5-year clinical outcomes of patients undergoing MACT in the knee joint. Search terms used were knee, matrix, and autologous chondrocyte. Patients were evaluated based on treatment failure rates, magnetic resonance imaging, and subjective outcome scores. Study methodology was assessed using the Modified Coleman Methodology Score (MCMS).Results:Ten studies (two level 1, one level 2, one level 3, and six level 4 evidence) were identified that met inclusion and exclusion criteria, for a total of 442 TF patients and 136 PF patients. Treatment failure occurred in 9.7% of all patients, including 4.7% of PF patients and 12.4% of TF patients (P = .037). Weighted averages of subjective outcome scores, including Knee injury and Osteoarthritis Outcome Score, Short Form–36 Health Survey, and Tegner scores, improved from baseline to latest follow-up in both TF and PF patients. The mean MCMS was found to be 57.4, with a standard deviation of 18.5.Conclusion:Patients undergoing MACT in the knee show favorable mid- to long-term clinical outcomes. A significantly higher treatment failure rate was found in patients undergoing MACT in the TF joint compared with the PF joint.

Patellofemoral Cartilage Repair

“…The authors criticized the heterogeneous description of failure among all studies and underlined the importance of a coherent definition of failure. Another systematic review looked at MACI outcomes in a 5-year follow-up period and found a significantly higher failure rate in the TF compared to the PFJ (12.4 vs. 4.7%) [ 23 •] (Table 1 )…”

“…of patients Mean patient age in years (range) Mean follow-up (range) Defect size, mean in cm 2 Outcomes Gomoll et al [ 7 ••] IV ACI 110 33 (15–55) 90 months (48–192) 5.4 84% good or excellent results, 9 failures (8%) which were treated with partial or total arthroplasty von Keudell et al [ 21 ••] IV ACI 30 32 (15–49) 7.3 years (2–15) 4.7 Good to excellent results in 25 (83%) patients, fair in 4 (13%) patients, poor in 1 (3%) patient, and 3 failures which were treated with PF and bicompartmental arthroplasty Ebert et al [ 20 ••] III MACI 194 37.7 (TF) vs. 37.9 (PF) 2 years 3.1 (TF) vs. 3.0 (PF) MACI in PF and TF shows similar results when PF maltracking is corrected if needed Andriolo et al [ 22 ••] IV ACI 4294 29 (21–51) 5–12.3 years 4.4 Failure rate of 14.9% (0–42.5) at 86 months. 64.0% of failures happened in the first 12 months, 26.1% between the second and fifth year, and 9.9% after the fifth year Schuette et al [ 23 •] IV MACI 578 31.3–42.3 Minimum 5–10 years 2.3–5.3 All scores significantly improved compared to baseline. In total, 9.7% of all patients failed, including 4.7% of PF patients and 12.4% of TF patients .…”

Trends in Decellularized Extracellular Matrix Bioinks for 3D Printing: Inspiring a new Kind of Medicine

“…Vascularized tissues are being produced, providing an opportunity to create complex tissues and organs [215,216]. New and improved ECMs or scaffolds such as biodegradable ECMs and polymers are available for many applications including cartilage and spinal cord repair [217][218][219]. Cells can deposit ECMs on scaffolds and later be removed through a decellularized process, leaving a graft that can be used for several applications [220][221][222].…”

Regeneration – eine neue therapeutische Dimension in der Hals-Nasen-Ohrenheilkunde

“…In 1994, Brittberg et al were the first to publish this procedure, in the New England Journal of Medicine. During the last 20 years, it has proven to be a significant clinical option 41 42 43 44 . In the meantime, it has become an alternative for traumatic defects, particularly in younger patients.…”