Acta Ortopédica Mexicana

Ortega-Orozco R, Olague-Franco JK, Miranda-Ramírez E
Autologous chondrocytes implantation versus microfracture for the treatment of knee cartilage lesions
Acta Ortop Mex 2018; 32 (6)

Language: Español
References: 30
Page: 322-328
PDF: 258.83 Kb.

[Fulltext - PDF]

ABSTRACT

Objective: To compare the clinical efficacy and safety of microfracture therapy (MF) versus implantation of autologous chondrocytes (MACI) in the management of chondral lesions of the knee ≥ 3 cm2 and follow up to 12 months post treatment. Material and methods: A retrospective cohort study was conducted from January 2016 to December 2017. Patients with one or more chondral lesions in knee ≥ 3 cm2 were included to compare MF versus MACI therapy for the repair of chondral lesion. Clinical and functional evaluations were carried out prior to the surgical treatment and 12 months later, with measurement of the range of motion, EVA, Oxford scale and Lequesne index. Results: Twelve patients were included in MF and 12 patients in MACI. The most frequent lesion was located in the Patella in eight patients (67%). It showed an increase in the arcs of motion, as well as improvement in the comparison between baseline and follow-up at 12 months: in EVA, MF demonstrated 48.4% and MACI 57.5% (p ≤ 0.05); Oxford scale: MF 32.65% and MACI 51.04% (p ≤ 0.05); index of Lequesne: MF 40.12% and MACI 50%. Two cases of joint effusion were presented in MACI, which were resolved with the realization of arthrotomies. Conclusion: In this study, significant improvement was demonstrated in MACI with pain relief, functionality, and range of motion compared to the treatment of MF in lesions ≥ 3 cm2 of the articular cartilage of the knee after one year of follow-up.


Key words: Implantation, chondrocyte, microfracture, chondral injuries.


REFERENCES

  1. Aroen A, Loken S, Heir S, Alvik E, Ekeland A, Granlund OG, Engebretsen L. Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med. 2004; 32(1): 211-5.

  2. Davies-Tuck ML, Wluka AE, Wang Y, Teichtahl AJ, Jones G, Ding C, et al. The natural history of cartilage defects in people with knee osteoarthritis. Osteoarthritis Cartilage. 2008; 16(3): 337-42.

  3. Sellards RA, Nho SJ, Cole BJ. Chondral injuries. Curr Opin Rheumatol. 2002; 14(2): 134-41.

  4. Brandt KD, Dieppe P, Radin E. Etiopathogenesis of osteoarthritis. Med Clin North Am. 2009; 93(1): 1-24, xv.

  5. Hangody L, Vásárhelyi G, Hangody LR, Sükösd Z, Tibay G, Bartha L, et al. Autologous osteochondral grafting-technique and long-term results. Injury. 2008; 39 (Suppl 1): S32-9.

  6. Alford JW, Cole BJ. Cartilage restoration, part 2: techniques, outcomes, and future directions. Am J Sports Med. 2005; 33(3): 443-60.

  7. Mithoefer K, Williams RJ 3rd, Warren RF, Potter HG, Spock CR, Jones EC, et al. Chondral resurfacing of articular cartilage defects in the knee with the microfracture technique. Surgical technique. J Bone Joint Surg Am. 2006; 88 Suppl. 1 Pt 2: 294-304.

  8. Williams RJ 3rd, Harnly HW. Microfracture: indications, technique, and results. Instr Course Lect. 2007; 56: 419-28.

  9. Mithoefer K, Williams RJ 3rd, Warren RF, Potter HG, Spock CR, Jones EC, et al. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am. 2005; 87: 1911-20.

  10. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994; 331(14): 889-95.

  11. Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E, Lindahl A. Two to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res. 2000; 374: 212-34.

  12. Gooding CR, Bartlett W, Bentley G, Skinner JA, Carrington R, Flanagan A. A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: periosteum covered versus type I/III collagen covered. Knee. 2006; 13(3): 203-10.

  13. Brittberg M. Cell carriers as the next generation of cell therapy for cartilage repair: a review of the matrix-induced autologous chondrocyte implantation procedure. Am J Sports Med. 2010; 38(6): 1259-71.

  14. Gigante A, Bevilacqua C, Ricevuto A, Mattioli-Belmonte M, Greco F. Membrane-seeded autologous chondrocytes: cell viability and characterization at surgery. Knee Surg Sports Traumatol Arthrosc. 2007; 15(1): 88-92.

  15. Knutsen G, Engebretsen L, Ludvigsen T, Drogset JO, Grøntvedt T, Solheim E, et al. Autologous chondrocyte implantation compared with microfracture in the knee: a randomized trial. J Bone Joint Surg Am. 2004; 86-A(3): 455-464.

  16. Roos EM, Engelhart L, Ranstam J, Anderson AF, Irrgang JJ, Marx RG, et al. ICRS recommendation document: patient-reported outcome instruments for use in patients with articular cartilage defects. Cartilage. 2011; 2(2): 122-36.

  17. Saris DB, Vanlauwe J, Victor J, Haspl M, Bohnsack M, Fortems Y, et al. Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med. 2008; 36(2): 235-46.

  18. Guillén-García P, Rodríguez-Iñigo E, Aráuz S, Guillén-Vicente M, Guillén-Vicente I y cols. Nuestra experiencia con la técnica de implante de condrocitos autólogos para el tratamiento de lesiones condrales: resultados de 50 pacientes a 2 años de seguimiento. Revista Española de Artroscopía y Cirugía Articular. 2015; 22(3): 120-5.

  19. Basad E, Ishaque B, Bachmann G, Sturz H, Steinmeyer J. Matrix induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomized study. Knee Surg Sports Traumatol Arthrosc. 2010; 18(4): 519-27.

  20. Marlovits S, Aldrian S, Wondrasch B, Zak L, Albrecht C, Welsch G, et al. Clinical and radiological outcomes 5 years after matrix-induced autologous chondrocyte implantation in patients with symptomatic, traumatic chondral defects. Am J Sports Med. 2012; 40(10): 2273-80.

  21. Moseley JB Jr, Anderson AF, Browne JE, Mandelbaum BR, Micheli LJ, Fu F, et al. Long-term durability of autologous chondrocyte implantation: a multicenter, observational study in US patients. Am J Sports Med. 2010; 38(2): 238-46.

  22. Ebert JR, Robertson WB, Woodhouse J, Fallon M, Zheng MH, Ackland T, et al. Clinical and magnetic resonance imaging-based outcomes to 5 years after matrix-induced autologous chondrocyte implantation to address articular cartilage defects in the knee. Am J Sports Med. 2011; 39(4): 753-63.

  23. Gill TJ. The treatment of articular cartilage defects using microfracture and debridement. Am J Knee Surg. 2000; 13(1): 33-40.

  24. Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003; 19(5): 477-84.

  25. Knutsen G, Drogset JO, Engebretsen L, Grøntvedt T, Isaksen V, Ludvigsen TC, et al. A randomized trial comparing autologous chondrocyte implantation with microfracture: findings at five years. J Bone Joint Surg Am. 2007; 89(10): 2105-12.

  26. Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M, et al. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage. 2006; 14 (11): 1119-25.

  27. Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med. 2009; 37(10): 2053-63.

  28. Mithoefer K, Saris DB, Farr J, Kon E, Zaslav K, Cole BJ, et al. Guidelines for the design and conduct of clinical studies in knee articular cartilage repair: International Cartilage Repair Society recommendations based on current scientific evidence and standards of clinical care. Cartilage. 2011; 2(2): 100-21.

  29. Vanlauwe J, Saris DB, Victor J, Almqvist KF, Bellemans J, Luyten FP. Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: early treatment matters. Am J Sports Med. 2011; 39(12): 2566-74.

  30. Ogura T, Mosier B, Bryant T, Minas T. A 20-year follow-up after first-generation autologous chondrocyte implantation. Am J Sports Med. 2017; 45(12): 2751-61.