TY - JOUR
T1 - Third-Generation Autologous Chondrocyte Implantation (Cells Cultured Within Collagen Membrane) Is Superior to Microfracture for Focal Chondral Defects of the Knee Joint
T2 - Systematic Review and Meta-analysis
AU - Dhillon, Jaydeep
AU - Decilveo, Alex P.
AU - Kraeutler, Matthew J.
AU - Belk, J. Wilson
AU - McCulloch, Patrick C.
AU - Scillia, Anthony J.
N1 - Funding Information:
P.C.M. reports consultant for Arthrex and research support from Smith & Nephew, outside the submitted work. A.J.S. reports consultant for Mitek; stock/stock options from Biomet, CONMED Linvatec, Johnson & Johnson, Pfizer, Smith & Nephew, and Stryker; and research support from Isto Biologics, outside the submitted work. ICMJE author disclosure forms are available for this article online, as supplementary material.
Publisher Copyright:
© 2022 Arthroscopy Association of North America
PY - 2022/8
Y1 - 2022/8
N2 - Purpose: To systematically review randomized controlled trials to compare clinical outcomes of microfracture (MFx) versus third-generation autologous chondrocyte implantation (ACI) for the treatment of focal chondral defects (FCDs) of the knee joint. Methods: A systematic review was performed by searching PubMed, Cochrane Library, and EMBASE to locate randomized controlled trials comparing minimum 2-year clinical outcomes of patients undergoing MFx versus third-generation ACI for FCDs of the knee joint. The search terms used were: “knee” AND “microfracture” AND “autologous chondrocyte” AND “randomized.” Patients were evaluated based on treatment failure rates, magnetic resonance imaging, International Cartilage Repair Society scores, and patient-reported outcome scores (Lysholm, Tegner, Knee Injury and Osteoarthritis Outcome Score, modified Cincinnati Knee Rating System, 12-item Short Form Health Survey Physical and Mental, and the EuroQol 5 Dimensions Visual Analog Scale score). Results: Six studies (5 Level I, 1 Level II) met inclusion criteria, including a total of 238 patients undergoing MFx and 274 undergoing ACI. Two studies had an overlapping cohort of patients and therefore the study with longer follow-up was used in all analyses. The average follow-up among patients ranged from 2.0 years to 6.0 years. Average lesion size ranged from 1.8 cm2 to 5.0 cm2. Treatment failure ranged from 0% to 1.8% in the ACI group and 2.5% to 8.3% in the MFx group. In 4 studies, ACI patients demonstrated significantly greater improvement in multiple Knee Injury and Osteoarthritis Outcome Score subscores compared with MFx. In 2 studies, patients who received ACI demonstrated significantly greater improvement in the Tegner score compared to MFx, and 1 study showed significantly greater improvement in the Lysholm and ICRS scores for ACI compared with MFx. Conclusions: At short-term follow-up, third-generation ACI demonstrates a lower failure rate and greater improvement in patient-reported outcomes compared with MFx for FCDs of the knee joint. Level of Evidence: II, systematic review of Levels I-II studies.
AB - Purpose: To systematically review randomized controlled trials to compare clinical outcomes of microfracture (MFx) versus third-generation autologous chondrocyte implantation (ACI) for the treatment of focal chondral defects (FCDs) of the knee joint. Methods: A systematic review was performed by searching PubMed, Cochrane Library, and EMBASE to locate randomized controlled trials comparing minimum 2-year clinical outcomes of patients undergoing MFx versus third-generation ACI for FCDs of the knee joint. The search terms used were: “knee” AND “microfracture” AND “autologous chondrocyte” AND “randomized.” Patients were evaluated based on treatment failure rates, magnetic resonance imaging, International Cartilage Repair Society scores, and patient-reported outcome scores (Lysholm, Tegner, Knee Injury and Osteoarthritis Outcome Score, modified Cincinnati Knee Rating System, 12-item Short Form Health Survey Physical and Mental, and the EuroQol 5 Dimensions Visual Analog Scale score). Results: Six studies (5 Level I, 1 Level II) met inclusion criteria, including a total of 238 patients undergoing MFx and 274 undergoing ACI. Two studies had an overlapping cohort of patients and therefore the study with longer follow-up was used in all analyses. The average follow-up among patients ranged from 2.0 years to 6.0 years. Average lesion size ranged from 1.8 cm2 to 5.0 cm2. Treatment failure ranged from 0% to 1.8% in the ACI group and 2.5% to 8.3% in the MFx group. In 4 studies, ACI patients demonstrated significantly greater improvement in multiple Knee Injury and Osteoarthritis Outcome Score subscores compared with MFx. In 2 studies, patients who received ACI demonstrated significantly greater improvement in the Tegner score compared to MFx, and 1 study showed significantly greater improvement in the Lysholm and ICRS scores for ACI compared with MFx. Conclusions: At short-term follow-up, third-generation ACI demonstrates a lower failure rate and greater improvement in patient-reported outcomes compared with MFx for FCDs of the knee joint. Level of Evidence: II, systematic review of Levels I-II studies.
KW - Cartilage Diseases
KW - Cartilage, Articular/surgery
KW - Chondrocytes/transplantation
KW - Collagen
KW - Fractures, Stress
KW - Humans
KW - Knee Injuries/surgery
KW - Knee Joint/surgery
KW - Osteoarthritis
KW - Transplantation, Autologous/methods
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U2 - 10.1016/j.arthro.2022.02.011
DO - 10.1016/j.arthro.2022.02.011
M3 - Review article
C2 - 35283221
AN - SCOPUS:85128126660
SN - 0749-8063
VL - 38
SP - 2579
EP - 2586
JO - Arthroscopy - Journal of Arthroscopic and Related Surgery
JF - Arthroscopy - Journal of Arthroscopic and Related Surgery
IS - 8
ER -