Erhan Basad1, Fabian R Wissing2, Patrick Fehrenbach3, Markus Rickert4, Jürgen Steinmeyer5, Bernd Ishaque6. 1. ATOS Clinic, Center for Knee and Hip Replacement and Regenerative Joint Surgery, Bismarckstrasse 9-15, 69115, Heidelberg, Germany. basad@atos.de. 2. Department for Trauma and Orthopedic Surgery, Asklepios Klinik Langen, Röntgenstrasse 20, 63225, Langen, Germany. fabian.r.wissing@googlemail.com. 3. Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany. p.fehrenbach@hotmail.de. 4. Department for Orthopaedic Surgery, Giessen University Hospital, Klinikstrasse 33, 35392, Giessen, Germany. markus.rickert@ortho.med.uni-giessen.de. 5. Laboratory for Experimental Orthopaedics, University of Giessen, Paul-Meimberg-Str.3, 35392, Giessen, Germany. juergen.steinmeyer@ortho.med.uni-giessen.de. 6. Department for Orthopaedic Surgery, Giessen University Hospital, Klinikstrasse 33, 35392, Giessen, Germany. bernd.ishaque@ortho.med.uni-giessen.de.
Abstract
PURPOSE: Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated effectiveness in treating isolated cartilage defects of the knee but medium- and long-term evidence and information on the management of postoperative complications or partially successful cases are sparse. This study hypothesised that MACI is effective for up to 5 years and that patients with posttreatment problems may go on to obtain clinical benefit from other interventions. METHODS: A follow-on, prospective case series of patients recruited into a previous controlled, randomised, prospective study or newly enroled. Patients were followed up 6, 12, 24 and 60 months after surgery. Outcome measures were Tegner (activity levels) and Lysholm (pain, stability, gait, clinical symptoms) scores. Zone-specific subgroups were analysed 6, 12 and 24 months postoperatively. RESULTS: Sixty-five patients were treated with MACI. Median Tegner score improved from II to IV at 12 months; an improvement maintained to 60 months. Mean Lysholm score improved from 28.5 to 76.6 points (±19.8) at 24 months, settling back to 75.5 points after 5 years (p > 0.0001). No significant differences were identified in the zone-specific analysis. Posttreatment issues (N = 12/18.5 %) were resolved with microfracture, debridement, OATS or bone grafting. CONCLUSIONS: MACI is safe and effective in the majority of patients. Patients in whom treatment is only partially successful can go on to obtain clinical benefit from other cartilage repair options. This study adds to the clinical evidence on the MACI procedure, offers insight into likely treatment outcomes, and highlights MACI's usefulness as part of an armamentarium of surgical approaches to the treatment of isolated knee defects. LEVEL OF EVIDENCE: Prospective case control study with no control group, Level III.
PURPOSE: Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated effectiveness in treating isolated cartilage defects of the knee but medium- and long-term evidence and information on the management of postoperative complications or partially successful cases are sparse. This study hypothesised that MACI is effective for up to 5 years and that patients with posttreatment problems may go on to obtain clinical benefit from other interventions. METHODS: A follow-on, prospective case series of patients recruited into a previous controlled, randomised, prospective study or newly enroled. Patients were followed up 6, 12, 24 and 60 months after surgery. Outcome measures were Tegner (activity levels) and Lysholm (pain, stability, gait, clinical symptoms) scores. Zone-specific subgroups were analysed 6, 12 and 24 months postoperatively. RESULTS: Sixty-five patients were treated with MACI. Median Tegner score improved from II to IV at 12 months; an improvement maintained to 60 months. Mean Lysholm score improved from 28.5 to 76.6 points (±19.8) at 24 months, settling back to 75.5 points after 5 years (p > 0.0001). No significant differences were identified in the zone-specific analysis. Posttreatment issues (N = 12/18.5 %) were resolved with microfracture, debridement, OATS or bone grafting. CONCLUSIONS: MACI is safe and effective in the majority of patients. Patients in whom treatment is only partially successful can go on to obtain clinical benefit from other cartilage repair options. This study adds to the clinical evidence on the MACI procedure, offers insight into likely treatment outcomes, and highlights MACI's usefulness as part of an armamentarium of surgical approaches to the treatment of isolated knee defects. LEVEL OF EVIDENCE: Prospective case control study with no control group, Level III.
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