Radoslav Zamborsky1, Lubos Danisovic2. 1. Department of Orthopaedics, Comenius University Bratislava and the National Institute of Children's Diseases, Bratislava, Slovakia; Expert Medical Services s.r.o, Bratislava, Slovakia. Electronic address: radozamborsky@gmail.com. 2. Institute of Medical Biology, Genetics and Clinical Genetics, Comenius University, Bratislava, Slovakia.
Abstract
PURPOSE: The aim of this study was to investigate the most appropriate surgical interventions for patients with knee articular cartilage defects from the level I randomized clinical trials. METHODS: We searched five databases for level I randomized clinical trials. Treatments were compared if reported in more than one study using network meta-analysis to boost the number of included studies per comparison. RESULTS: We studied 21 articles that included 891 patients. Traumatic lesion was the most common cause in the included patients. There were significantly higher failure rates in the microfracture (MF) group compared to autologous chondrocyte implantation (ACI) group at 10-year follow-up. Moreover, osteochondral autograft transplantation (OAT) showed significantly more excellent or good results at > 3-year follow-up compared to MF, whereas MF showed significantly more poor results versus ACI and matrix-induced autologous chondrocyte implantation (MACI). Furthermore, OAT showed significantly more poor results than MACI at 1-year follow-up. Similarly, patients who underwent OAT had higher return-to-activity rates than those with MF. It is noteworthy that the Knee injury and Osteoarthritis Outcome Score was higher in patients who underwent characterized chondrocyte implantation or MACI compared to MF. Finally, there were no significant differences among the various interventions regarding reintervention, biopsy types or adverse events. According to the P scores for interventions ranking, there was a disagreement concerning the best intervention; however, MF was always ranked as the last. CONCLUSIONS: Cartilage repair techniques, rather than MF, provide higher quality repair of tissue and have lower failure and higher return-to-activity rates. Moreover, OAT had significantly more excellent or good results compared to MF, whereas MF had significantly more poor results than ACI and MACI. Future studies need to have longer follow-up periods and more representative populations to investigate the efficacy and safety of these interventions. LEVEL OF EVIDENCE: Level I: meta-analysis of Level I studies.
PURPOSE: The aim of this study was to investigate the most appropriate surgical interventions for patients with knee articular cartilage defects from the level I randomized clinical trials. METHODS: We searched five databases for level I randomized clinical trials. Treatments were compared if reported in more than one study using network meta-analysis to boost the number of included studies per comparison. RESULTS: We studied 21 articles that included 891 patients. Traumatic lesion was the most common cause in the included patients. There were significantly higher failure rates in the microfracture (MF) group compared to autologous chondrocyte implantation (ACI) group at 10-year follow-up. Moreover, osteochondral autograft transplantation (OAT) showed significantly more excellent or good results at > 3-year follow-up compared to MF, whereas MF showed significantly more poor results versus ACI and matrix-induced autologous chondrocyte implantation (MACI). Furthermore, OAT showed significantly more poor results than MACI at 1-year follow-up. Similarly, patients who underwent OAT had higher return-to-activity rates than those with MF. It is noteworthy that the Knee injury and Osteoarthritis Outcome Score was higher in patients who underwent characterized chondrocyte implantation or MACI compared to MF. Finally, there were no significant differences among the various interventions regarding reintervention, biopsy types or adverse events. According to the P scores for interventions ranking, there was a disagreement concerning the best intervention; however, MF was always ranked as the last. CONCLUSIONS: Cartilage repair techniques, rather than MF, provide higher quality repair of tissue and have lower failure and higher return-to-activity rates. Moreover, OAT had significantly more excellent or good results compared to MF, whereas MF had significantly more poor results than ACI and MACI. Future studies need to have longer follow-up periods and more representative populations to investigate the efficacy and safety of these interventions. LEVEL OF EVIDENCE: Level I: meta-analysis of Level I studies.
Authors: Pavel Neckar; Hana Potockova; Jaroslav Branis; Vojtech Havlas; Tomas Novotny; Dominika Lykova; Jana Gujski; Ivana Drahoradova; Katerina Ruzickova; Jana Kaclova; Petr Skala; Peter O Bauer Journal: Int Orthop Date: 2022-07-19 Impact factor: 3.479
Authors: P Niemeyer; M Hanus; J Belickas; T László; R Gudas; M Fiodorovas; A Cebatorius; M Pastucha; P Hoza; K Magos; K Izadpanah; L Paša; G Vásárhelyi; K Sisák; M Mohyla; C Farkas; O Kessler; S Kybal; R Spiro; A Köhler; A Kirner; S Trattnig; C Gaissmaier Journal: Cartilage Date: 2022 Jan-Mar Impact factor: 3.117
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