Survival Analysis of Microfracture in the Osteoarthritic Knee—Minimum 10-Year Follow-up

Bae, Dae Kyung; Song, Sang Jun; Yoon, Kyoung Ho; Heo, Dong Beom; Kim, Tae Jin

doi:10.1016/j.arthro.2012.09.006

Cited by 51 publications

(68 citation statements)

References 31 publications

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“…The bathtub model was investigated because it has previously been found useful for modelling failure rates after total hip replacement. 133 Linearly increasing hazard models were tried because MF failure rate during 12 years of follow-up of patients with OA (Bae et al, 134 an excluded study for this report, because patients had OA and were older) was found to be best fit with such models. They were therefore judged to be worth investigating.…”

Section: Methodsmentioning

confidence: 99%

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

Mistry

Connock

Pink

et al. 2017

Health Technol Assess

201

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: Methodsmentioning

confidence: 99%

“…Graphs-of-model fits for included studies that are most relevant to the decision problem are presented, arranged by study in alphabetical order. Other appendices provide model information for the MF study of Bae et al, 134 Gudas et al 128 and the unpublished ACTIVE trial.…”

Section: Web Of Science Core Collection 2010 To June 2014mentioning

confidence: 99%

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

Mistry

Connock

Pink

et al. 2017

Health Technol Assess

201

164

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“…In that study, the authors performed conventional microfracture in osteoarthritic knees and noted an average joint space improvement of 1.06 mm on weight bearing AP radiographs taken at a mean of 27 months postoperatively [27]. This improvement in joint space, however, did not persist after 10 years of follow-up [28]. The longevity of the joint space restoration in our patients is of course unknown.…”

Section: Discussionmentioning

confidence: 91%

Biologic Augmented Microdrilling Surgery for Multiple and Large Full-Thickness Cartilage Lesions in the Knee: Early Clinical and Radiological Results

Broyles¹,

O’Brien²,

Broyles³

et al. 2017

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Background: Various biologic treatments are available for articular cartilage lesions in the knee, but no one exists that is applicable to the full range of chondral disease and that is compliant with United States Food and Drug Administration regulations. The aim of this study was to evaluate outcomes following microdrilling surgery augmented with postoperative injections of bone marrow aspirate concentrate (BMAC), platelet rich plasma (PRP) and hyaluronic acid (HA). Methods: Eighteen patients with at least one symptomatic, full-thickness chondral lesion underwent arthroscopic microdrilling surgery. Immediately following surgery, patients received an intra-articular injection of fresh BMAC, PRP, and HA. This injection was repeated once per week for 5 consecutive weeks. At 4 and 12 months postoperatively, patients received 3 additional weekly injections for a total of 12 injections. Outcome Measures: IKDC (International Knee Documentation Committee) scores, KS (Knee Society) scores and plain radiographs. Results: The mean treated area was 6.2 ± 4.5 (range, 0.6 -14.7) cm 2 . The mean preoperative IKDC and KS scores (±SE) were 43.0 ± 3.2 and 68.3 ± 3.6 respectively. At 24 months postoperatively, IKDC and KS scores improved to 85.3 ± 4.2 and 94.7 ± 4.4, respectively; both changes from baseline were significant (p < 0.001). Radiographic analysis revealed that 9 of 18 patients in this series had joint space (JS) narrowing preoperatively. At 24 months, there was a 0.7 ± 0.3 mm overall increase in JS (p = 0.05). This change was greater in patients with preoperative JS < 2 mm, with an increase of 1.4 ± 0.5 mm (p for the difference between groups = 0.1). Conclusions: Microdrilling of cartilage lesions augmented with BMAC, PRP, and HA may be a viable treatment for a range of chondral disease with good early clinical and radiological results.

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“…The first procedure, MF, is a marrow stimulation technique, whereby a full-thickness chondral defect is created, including removal of calcified cartilage, followed by puncturing the underlying subchondral bone with a drill or awl to create small holes for bone marrow constituents, including MSCs, to fill the defect. 54,55 The resulting tissue is less durable, less organized, and has a higher quantity of collagen type I than normal articular cartilage. 56 Poor clinical outcomes from MF have been associated with inadequate filling of defect with repair tissue and osseous overgrowth.…”

Section: Surgical Techniquesmentioning

confidence: 99%

A Road Map to Commercialization of Cartilage Therapy in the United States of America

Sridharan

Detamore

2016

Tissue Engineering Part B: Reviews

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Survival Analysis of Microfracture in the Osteoarthritic Knee—Minimum 10-Year Follow-up

Cited by 51 publications

References 31 publications

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

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

Biologic Augmented Microdrilling Surgery for Multiple and Large Full-Thickness Cartilage Lesions in the Knee: Early Clinical and Radiological Results

A Road Map to Commercialization of Cartilage Therapy in the United States of America

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