Martin O Brix1, David Stelzeneder2, Catharina Chiari2, Ulrich Koller2, Stefan Nehrer3, Ronald Dorotka4, Reinhard Windhager2, Stephan E Domayer5. 1. Department of Orthopaedics, Medical University of Vienna, Vienna, Austria martin.brix@meduniwien.ac.at. 2. Department of Orthopaedics, Medical University of Vienna, Vienna, Austria. 3. Danube University Krems, Krems, Austria. 4. Orthopaedic City Center, Vienna, Austria. 5. Department of Orthopaedics, Medical University of Vienna, Vienna, Austria Orthopaedic Rehabilitation Center SKA Zicksee, St Andrä am Zicksee, Austria.
Abstract
BACKGROUND: Matrix-associated autologous chondrocyte transplantation (MACT) has become an established articular cartilage repair technique. It provides good short-term and midterm results; however, long-term results are lacking. PURPOSE: To prospectively assess the clinical outcome after MACT in the knee to report long-term results. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Fifty-three subjects (females/males, 22/31; mean age, 32 ± 12 years) were treated between 2000 and 2006 with a hyaluronan-based MACT product and were followed prospectively. The mean body mass index (BMI) was 24.5 ± 3.8 kg/m(2) and the mean defect size was 4.4 ± 1.9 cm(2). Fifty patients had single defects and 3 had multiple defects (41 medial femoral condyle, 6 lateral femoral condyle, 2 patella, 1 tibia). Two patients had 2 defects (medial femoral condyle [MFC]/lateral femoral condyle and tibial/MFC), and in 1 case, multiple defects on the MFC were treated. The patients were stratified into 23 "simple," 22 "complex," and 8 "salvage" cases. Instability or malalignment was treated before or at the time of graft implantation. For 6 patients with small defects (<2 cm(2)), microfracturing was used as first-line treatment before MACT. Clinical assessment was performed once a year with the subjective and objective International Knee Documentation Committee (IKDC) scores, Lysholm score, and a modified Cincinnati Knee Rating System. RESULTS: The mean follow-up time was 9.07 ± 2.9 years (range, 5-12 years). Treatment failure occurred in 12 of 53 cases (22.6%) an average of 2.99 ± 1.40 years after surgery. There was 1 failure (4.3%) among the simple cases, 4 failures (18.2%) in complex cases, and 7 failures (87.5%) in salvage cases. Statistically significant increases were observed in all scores at all time points compared with presurgery levels (P < .05). The subjective IKDC score improved from median 40.4 preoperatively to 74.7 at 10-year follow-up (n = 13 patients; P < .05). CONCLUSION: MACT is an excellent surgical therapy for full-thickness cartilage defects of the knee, with good long-term results for simple defects. However, it should not be used in salvage cases.
BACKGROUND: Matrix-associated autologous chondrocyte transplantation (MACT) has become an established articular cartilage repair technique. It provides good short-term and midterm results; however, long-term results are lacking. PURPOSE: To prospectively assess the clinical outcome after MACT in the knee to report long-term results. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Fifty-three subjects (females/males, 22/31; mean age, 32 ± 12 years) were treated between 2000 and 2006 with a hyaluronan-based MACT product and were followed prospectively. The mean body mass index (BMI) was 24.5 ± 3.8 kg/m(2) and the mean defect size was 4.4 ± 1.9 cm(2). Fifty patients had single defects and 3 had multiple defects (41 medial femoral condyle, 6 lateral femoral condyle, 2 patella, 1 tibia). Two patients had 2 defects (medial femoral condyle [MFC]/lateral femoral condyle and tibial/MFC), and in 1 case, multiple defects on the MFC were treated. The patients were stratified into 23 "simple," 22 "complex," and 8 "salvage" cases. Instability or malalignment was treated before or at the time of graft implantation. For 6 patients with small defects (<2 cm(2)), microfracturing was used as first-line treatment before MACT. Clinical assessment was performed once a year with the subjective and objective International Knee Documentation Committee (IKDC) scores, Lysholm score, and a modified Cincinnati Knee Rating System. RESULTS: The mean follow-up time was 9.07 ± 2.9 years (range, 5-12 years). Treatment failure occurred in 12 of 53 cases (22.6%) an average of 2.99 ± 1.40 years after surgery. There was 1 failure (4.3%) among the simple cases, 4 failures (18.2%) in complex cases, and 7 failures (87.5%) in salvage cases. Statistically significant increases were observed in all scores at all time points compared with presurgery levels (P < .05). The subjective IKDC score improved from median 40.4 preoperatively to 74.7 at 10-year follow-up (n = 13 patients; P < .05). CONCLUSION: MACT is an excellent surgical therapy for full-thickness cartilage defects of the knee, with good long-term results for simple defects. However, it should not be used in salvage cases.
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Authors: Giuseppe Filardo; Luca Andriolo; Peter Angele; Massimo Berruto; Mats Brittberg; Vincenzo Condello; Susan Chubinskaya; Laura de Girolamo; Alessandro Di Martino; Berardo Di Matteo; Justus Gille; Alberto Gobbi; Christian Lattermann; Norimasa Nakamura; Stefan Nehrer; Giuseppe M Peretti; Nogah Shabshin; Peter Verdonk; Kenneth Zaslav; Elizaveta Kon Journal: Cartilage Date: 2020-01-15 Impact factor: 3.117