Scaffold-associated procedures are superior to microfracture in managing focal cartilage defects in the knee: A systematic review &amp; meta-analysis

Seewoonarain, Sheena; Ganesh, Divolka; Perera, Edward; Popat, Ravi; Jones, Julian R.; Sugand, Kapil; Gupte, Chinmay

doi:10.1016/j.knee.2023.04.001

Cited by 3 publications

(2 citation statements)

References 45 publications

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“…Several surgical techniques have been proposed to try to improve the regeneration of the articular cartilage. They can be broadly divided into bone marrow stimulation with microfractures (MF), cartilage replacement, and cartilage regeneration [8].…”

Section: Introductionmentioning

confidence: 99%

“…Despite these benefits, there is still an ongoing debate on whether surgical treatment with MF is superior to scaffold-associated procedures for the treatment of large chondral defects, primarily due to a lack of standardization in techniques, differences in study designs, and poor outcome definitions, rendering the use of this new approach limited [8]. Additionally, there is a wide array of scaffold designs, and therefore there is a need to elucidate the optimal scaffold option for future human trials to advocate for homogeneity in terms of exposures.…”

Section: Introductionmentioning

confidence: 99%

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Rapid Recovery after Reparation of Full-Thickness Chondral Defects of the Knee with the Use of Hyaluronan (HA)-Based 3-D Scaffold

Valladares,

Cabrero Montes,

Jacobo-Jimenez

et al. 2023

JFB

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Articular cartilage injuries are found in up to 60% of patients who undergo an arthroscopic knee procedure, and those that totally affect articular cartilage (grade IV) have limited regenerative capacity and extended time for recovery. 3-D scaffolds represent a novel solution to address this type of injury. Our purpose was to analyze the MRI findings and functional status of patients that underwent repair of chondral defects either by microfractures or Hyaluronan (HA) 3-D scaffolding. We conducted a retrospective study of patients with chondral defects. The outcomes analyzed in this study included anatomical changes evaluated by the Henderson score (based on MRI findings) at baseline, 6, and 12 months after surgery, and improvement in functionality evaluated by the Modified Cincinnati Knee Rating System (MCKRS) at baseline and 6 months after surgery. Clinical and demographic characteristics were similar for both groups. There was a statistically significant improvement in Henderson score for the 3-D scaffold-treated group at 6 months versus the microfracture group (p < 0.0001). Improvement in functionality, measured by the MCKRS, was more frequently found in the 3-D scaffold-treated group. In conclusion, the use of HA 3-D scaffolding was superior, with faster recovery evident 6 months after the surgery that progressed to full recovery in all patients a year after surgery. Future studies with a randomized design might help to support our findings. This study provides level III evidence.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rapid Recovery after Reparation of Full-Thickness Chondral Defects of the Knee with the Use of Hyaluronan (HA)-Based 3-D Scaffold

Valladares,

Cabrero Montes,

Jacobo-Jimenez

et al. 2023

JFB

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Drop in survivorship 13 years after AMIC procedures in aligned knees: A long‐term follow‐up

Barrera Uso,

Boillat,

Blümel

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeAutologous matrix‐induced chondrogenesis (AMIC) showed promising short‐term results comparable to microfracture. This study aims to assess the 19‐year outcomes of AMIC, addressing the lack of long‐term data.MethodsRetrospective cohort of 34 knees treated with AMIC underwent a 19‐year follow‐up. The primary outcome was AMIC survival, considering total knee arthroplasty as a failure event. Survival analysis for factors that were associated with longer survival of the AMIC was also performed. Clinical and radiological outcome scores were analysed for the AMIC group.ResultsTwenty‐three knees were available for follow‐up analysis. Of these, 14 (61%) underwent revision surgery for total knee arthroplasty (TKA). The mean time was 13.3 ± 2.5 years (range: 9–17 years). Secondary outcomes showed that increased age at surgery (hazard ratio [HR]: 1.05; p = 0.021) and larger defect size (HR: 1.95; p = 0.018) were risk factors for failure. Concomitant proximal tibial osteotomy (HR: 0.22; p = 0.019) was associated with longer survival. The remaining nine knees (39%) were analysed as a single group. The mean clinical score at follow‐up of 18.6 ± 0.9 SD years was 79.5 ± 19.7 SD for the Lysholm score, 1.8 ± 1.5 SD for the visual analog scale score, 74.2 ± 22.4 SD for the KOOS score and a median of 3 (range: 3–4) for the Tegner activity scale.ConclusionsThe mean survival time of 13.3 years indicates the durability of AMIC in properly aligned knees. Nonetheless, despite a 61% conversion to TKA, the knees that persisted until the 19‐year follow‐up remained stable, underscoring the procedure's longevity and consistent clinical outcomes.Level of EvidenceLevel IV.

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A randomized controlled trial demonstrating sustained benefit of autologous matrix-induced chondrogenesis (AMIC®) over microfracture: 10-year follow-up

Volz,

Schaumburger,

Gellißen

et al. 2024

Eur J Orthop Surg Traumatol

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Purpose Autologous matrix-induced chondrogenesis (AMIC®) and microfracture are established treatments for focal chondral defects in the knee, but there are little clinical data concerning these procedures over the long term. This study evaluates the outcomes of AMIC® compared to microfracture over 10-year follow-up. Methods Forty-seven patients were randomized and treated either with MFx (n = 13), sutured AMIC® (n = 17) or glued AMIC® (n = 17) in a prospective, randomized, controlled multicentre trial. The Modified Cincinnati Knee Score, a visual analogue scale for pain and MOCART score were used to assess outcomes over 10 years post-operatively. Results All treatment arms improved in the first 2 years, but a progressive and significant deterioration in scores was observed in the MFx group, while both AMIC® groups remained stable. MOCART scores were comparable between groups. Conclusion The AMIC® procedure results in improved patient outcomes in comparison with microfracture up to 10 years following surgery for the repair of focal chondral defects in the knee. ClinicalTrials.gov Identifier: NCT02993510

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Scaffold-associated procedures are superior to microfracture in managing focal cartilage defects in the knee: A systematic review & meta-analysis

Cited by 3 publications

References 45 publications

Rapid Recovery after Reparation of Full-Thickness Chondral Defects of the Knee with the Use of Hyaluronan (HA)-Based 3-D Scaffold

Rapid Recovery after Reparation of Full-Thickness Chondral Defects of the Knee with the Use of Hyaluronan (HA)-Based 3-D Scaffold

Drop in survivorship 13 years after AMIC procedures in aligned knees: A long‐term follow‐up

A randomized controlled trial demonstrating sustained benefit of autologous matrix-induced chondrogenesis (AMIC®) over microfracture: 10-year follow-up

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