Systematic Review and Meta-Analysis of the Clinical Evidence on the Use of Autologous Matrix-Induced Chondrogenesis in the Knee

Abstract

Objective A systematic review and meta-analysis of Autologous Matrix-Induced Chondrogenesis (AMIC®) outcomes for grade III/IV chondral and osteochondral lesions of the knee treated with Chondro-Gide®. Design Studies with a minimum follow-up of 1 year providing clinical results of AMIC repair in the knee were included based on PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Methodological quality was assessed by the modified Coleman Methodology Score (mCMS). The meta-analysis was comparing pain VAS (Visual Analog Scale), Lysholm score, and IKDC score (International Knee Documentation Committee) between baseline and follow-up after 1 or 2 years and after >3 years. Results Twelve studies (375 patients) were included. The mCMS demonstrated a suboptimal study design (ranking between 52 and 80). The mean age was 36.2 years (14-70 years). The mean defect size was 4.24 cm2 (0.8-22 cm2). The results from the random effects model indicated a clinically significant ( P < 0.05) improvement of pain VAS from baseline to follow-up at year 1 to 2 of −4.02(confidence interval −4.37; −3.67), still significant after 3 years. Lysholm score at year 1 or 2 improved significantly and remained highly significant after 3 years. IKDC score showed highly significant improvement of 32.61 between 1 and 2 years versus baseline values maintained after 3 years. Conclusions The AMIC procedure significantly improved the clinical status and functional scoring versus preoperative values. Evidence was obtained in a non-selected patient population, corresponding to real-life treatment of knee chondral and osteochondral defects. The evidence is sufficient to recommend AMIC in this indication.

Autologous Matrix-Induced Chondrogenesis for Treatment of Focal Cartilage Defects in the Knee: A Follow-up Study

“…Our results are in accordance with the results of a recent AMIC meta-analysis based on 12 studies (11 level 4 studies and 1 level 1 study) that included a total of 375 patients. 37 Most patients were very satisfied with the result of the index procedure and would choose to undergo the same procedure again, if needed. This is in agreement with our previous reported results at midterm follow-up.…”

Mechanotransduction and Stiffness-Sensing: Mechanisms and Opportunities to Control Multiple Molecular Aspects of Cell Phenotype as a Design Cornerstone of Cell-Instructive Biomaterials for Articular Cartilage Repair

“…Microfracture, which is one of the most commonly performed surgical AC repair procedures, relies on the influx of MSCs from the surgically penetrated subchondral bone, to initiate (fibro-)cartilaginous repair [ 35 ] of small localized AC defects [ 31 ]. Moreover, MSCs are being used in an emerging clinical procedure termed “autologous matrix-induced chondrogenesis” (AMIC™), which, like microfracture, utilizes the influx of MSCs from the surgically penetrated subchondral bone, but in conjunction with administration of a collagen type I/III membrane [ 36 , 37 ].…”

AMIC—Autologous Matrix-Induced Chondrogenesis Technique in Patellar Cartilage Defects Treatment: A Retrospective Study with a Mid-Term Follow-Up

“…The AMIC technique is a one-step procedure for the treatment of knee cartilage defects. Many authors have reported good or excellent clinical results at mid-term follow-up in the management of knee chondral defects [25].…”

“…Satisfactory results, in terms of pain reduction and functional improvement, have been already reported for up to 7 years [14,[18][19][20][21][22][23][24]. A very recent meta-analysis concerning the clinical evidence on the use of AMIC in the knee confirmed that it can be recommended for the treatment of knee chondral and osteochondral defects [25]. In particular, good outcomes were also demonstrated in patients presenting patellofemoral cartilage defects although at a short follow-up [26,27].…”