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Randsborg PH, Brinchmann JE, Owesen C, Engebretsen L, Birkenes T, Hanvold HA, Benth JŠ, Årøen A. Autologous Chondrocyte Implantation Is Not Better Than Arthroscopic Debridement for the Treatment of Symptomatic Cartilage Lesions of the Knee: Two-Year Results From a Randomized-Controlled Trial. Arthrosc Sports Med Rehabil 2024; 6:100909. [PMID: 38495635 PMCID: PMC10943062 DOI: 10.1016/j.asmr.2024.100909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/07/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose To compare the functional and patient-reported outcome measures after autologous chondrocyte implantation (ACI) and arthroscopic debridement (AD) in symptomatic, isolated cartilage injuries larger than 2 cm2 in patients aged 18 to 50 years. Methods Twenty-eight patients were included and randomized to ACI (n = 15) or AD (n = 13) and followed for 2 years. The primary outcome was the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscale. Results The mean age at inclusion was 34.1 (standard deviation [SD] 8.5) years. There were 19 (68%) male patients. The mean size of the lesion was 4.2 (SD 1.7) cm2. There was a statistically significant and clinically meaningful improvement in patient-reported outcome measures from baseline to 2 years in both groups. The improvement from baseline to final follow-up for the primary endpoint (the KOOS QoL subscale) was larger for the AD group (39.8, SD 9.4) compared with the ACI group (23.8, SD 6.7), but this difference was not statistically significant (P = .17). However, according to a mixed linear model there were statistically significantly greater scores in the AD group for several KOOS subscales at several time points, including KOOS QoL, KOOS pain, and KOOS sport and recreation at 2 years. Conclusions This study indicates that AD followed by supervised physiotherapy is equal to or better than ACI followed by supervised physiotherapy in patients with isolated cartilage lesions of the knee larger than 2 cm2. The improvement in KOOS QoL score from baseline to 2 years was clinically meaningful for both groups (23.8 points for ACI and 39.8 points AD), and larger for the AD group by 16 points. Level of Evidence Level I, prospective randomized controlled trial.
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Affiliation(s)
- Per-Henrik Randsborg
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Jan E. Brinchmann
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Christian Owesen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Lars Engebretsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Thomas Birkenes
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Sports Traumatology and Arthroscopy Research Group, Bergen, Norway
| | | | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Asbjørn Årøen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
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Bei M, Zheng Z, Xiao Y, Liu N, Cao X, Tian F, Zhang L, Wu X. Effects of alendronate on cartilage lesions and micro-architecture deterioration of subchondral bone in patellofemoral osteoarthritic ovariectomized rats with patella-baja. J Orthop Surg Res 2024; 19:197. [PMID: 38528611 DOI: 10.1186/s13018-024-04677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/14/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Patellofemoral osteoarthritis (PFJOA) is a subtype of knee OA, which is one of the main causes of anterior knee pain. The current study found an increased prevalence of OA in postmenopausal women, called postmenopausal OA. Therefore, we designed the ovariectomized rat model of patella baja-induced PFJOA. Alendronate (ALN) inhibits osteoclast-mediated bone loss, and has been reported the favorable result of a potential intervention option of OA treatment. However, the potential effects of ALN treatment on PFJOA in the ovariectomized rat model are unknown and need further investigation prior to exploration in the clinical research setting. In this study, the effects of ALN on articular cartilage degradation and subchondral bone microstructure were assessed in the ovariectomized PFJOA rat model for 10 weeks. METHODS Patella baja and estrogen withdrawal were induced by patellar ligament shortening (PLS) and bilateral ovariectmomy surgeries in 3-month-old female Sprague-Dawley rats, respectively. Rats were randomly divided into five groups (n = 8): Sham + V; OVX + V, Sham + PLS + V, OVX + PLS + V, OVX + PLS + ALN (ALN: 70 μg/kg/week). Radiography was performed to evaluate patellar height ratios, and the progression of PFJOA was assessed by macroscopic and microscopic analyses, immunohistochemistry and micro-computed tomography (micro-CT). RESULTS Our results found that the patella baja model prepared by PLS can successfully cause degeneration of articular cartilage and subchondral bone, resulting in changes of PFJOA. OVX caused a decrease in estrogen levels in rats, which aggravated the joint degeneration caused by PFJOA. Early application of ALN can delay the degenerative changes of articular cartilage and subchondral bone microstructure in castrated PFJOA rat to a certain extent, improve and maintain the micrometabolism and structural changes of cartilage and subchondral bone. CONCLUSION The early application of ALN can delay the destruction of articular cartilage and subchondral bone microstructure in castrated PFJOA rat to a certain extent.
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Affiliation(s)
- Mingjian Bei
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital Affiliated to Capital Medical University, Xinjiekoudongjie 31, Xicheng Dis, Beijing, 100035, People's Republic of China
| | - Zhiyuan Zheng
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, People's Republic of China
| | - Yaping Xiao
- The Department of Orthopedic Surgery, Wuhan Third Hospital, Tongren Hospital of Wuhan University, No. 241, Pengliuyang Road, Wuhan, 430000, People's Republic of China
| | - Ning Liu
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, People's Republic of China
| | - Xuehui Cao
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, People's Republic of China
| | - Faming Tian
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, People's Republic of China
| | - Liu Zhang
- Department of Orthopedic Surgery, Emergency General Hospital, Xibahenanli 29, Chaoyang District, Beijing, 100028, People's Republic of China
| | - Xinbao Wu
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital Affiliated to Capital Medical University, Xinjiekoudongjie 31, Xicheng Dis, Beijing, 100035, People's Republic of China.
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Gaissmaier C, Angele P, Spiro RC, Köhler A, Kirner A, Niemeyer P. Hydrogel-Based Matrix-Associated Autologous Chondrocyte Implantation Shows Greater Substantial Clinical Benefit at 24 Months Follow-Up than Microfracture: A Propensity Score Matched-Pair Analysis. Cartilage 2024:19476035241235928. [PMID: 38501741 DOI: 10.1177/19476035241235928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE To compare substantial clinical benefit (SCB) of a hydrogel-based, matrix-associated autologous chondrocyte implantation (M-ACI) method versus microfracture (MFx) in the treatment of knee cartilage defects. DESIGN Propensity score matched-pair analysis, using the MFx control group of a phase III study as comparator for M-ACI treatment in a single-arm phase III study, resulting in 144 patients in the matched-pair set. RESULTS Groups were comparable regarding baseline Knee Injury and Osteoarthritis Outcome Score (KOOS), sex, age, body mass index, symptom duration, smoking status, and previous knee surgeries. Defect sizes in the M-ACI group were significantly larger than in the MFx group (6.4 cm2 vs. 3.7 cm2). Other differences concerned location, number, and etiology of defects that were not considered to influence the interpretation of results. At 24 months, significantly more patients in the M-ACI group achieved SCB in KOOS pain (72.2% vs. 48.6%; P = 0.0108), symptoms (84.7% vs. 61.1%, P = 0.0039), sports/recreation (84.7% vs. 56.9%, P = 0.0008), and quality of life (QoL; 72.2% vs. 44.4%, P = 0.0014). The SCBs for KOOS activities in daily living and International Knee Documentation Committee score were higher for M-ACI but not significantly different from MFx. The SCB rates consistently favored M-ACI from 3 months onward. The highest improvements from baseline at 24 months in patients with SCB were observed for KOOS sports/rec. (M-ACI: 60.8 points, MFx: 55.9 points) and QoL (M-ACI: 58.1, MFx: 57.4). CONCLUSION Hydrogel-based M-ACI demonstrated superior SCB in KOOS pain, symptoms, sports/rec., and QoL compared with MFx in patients with knee cartilage defects through 2 years follow-up.
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Affiliation(s)
| | - Peter Angele
- Sporthopaedicum Regensburg, Regensburg, Germany
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | | | - Annette Köhler
- TETEC-Tissue Engineering Technologies AG, Reutlingen, Germany
| | | | - Philipp Niemeyer
- OCM Orthopädische Chirurgie München, Munich, Germany
- Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Albert Ludwig University of Freiburg, Freiburg, Germany
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Birkenes T, Furnes O, Lygre SHL, Solheim E, Årøen A, Knutsen G, Drogset JO, Heir S, Engebretsen L, Løken S, Visnes H. Previous cartilage surgery is associated with inferior patient-reported outcomes after knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:361-370. [PMID: 38294966 DOI: 10.1002/ksa.12050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE The hypothesis of the present study assumed that a history of focal cartilage lesions would not affect Knee Injury and Osteoarthritis Outcome scores (KOOSs) following knee arthroplasty compared to a matched national cohort of knee arthroplasty patients. METHODS Fifty-eight knee arthroplasty patients with previous surgery for focal cartilage lesions (cartilage cohort) were compared to a matched cohort of 116 knee arthroplasty patients from the Norwegian Arthroplasty Register (control group). Age, sex, primary or revision arthroplasty, type of arthroplasty (total, unicondylar or patellofemoral), year of arthroplasty surgery and arthroplasty brand were used as matching criteria. Demographic data and KOOS were obtained through questionnaires. Regression models were employed to adjust for confounding factors. RESULTS Mean follow-up post knee arthroplasty surgery was 7.6 years (range 1.2-20.3) in the cartilage cohort and 8.1 (range 1.0-20.9) in the control group. The responding patients were at the time of surgery 54.3 versus 59.0 years in the cartilage and control group, respectively. At follow-up the control group demonstrated higher adjusted Knee Injury and Osteoarthritis Outcome subscores than the previous focal cartilage patients with a mean adjusted difference (95% confidence interval in parentheses): Symptoms 8.4 (0.3, 16.4), Pain 11.8 (2.2, 21.4), Activities of daily living (ADL) 9.3 (-1.2, 18.6), Sport and recreation 8.9 (-1.6, 19.4) and Quality of Life (QoL) 10.6 (0.2, 21.1). The control group also demonstrated higher odds of reaching the patient-acceptable symptom state threshold for the Knee Injury and Osteoarthritis Outcome subscores with odds ratio: Symptoms 2.7 (1.2, 6.4), Pain 3.0 (1.3, 7.0), ADL 2.1 (0.9, 4.6) and QoL 2.4 (1.0, 5.5). CONCLUSION Previous cartilage surgery was associated with inferior patient-reported outcomes after knee arthroplasty. These patients also exhibited significantly lower odds of reaching the patient-acceptable symptom state threshold for the Knee Injury and Osteoarthritis Outcome subscores. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Thomas Birkenes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Sports Traumatology and Arthroscopy Research Group, Bergen, Norway
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Stein Håkon Låstad Lygre
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Eirik Solheim
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Asbjørn Årøen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Akershus University Hospital, Lorenskog, Norway
- Oslo Sports Trauma Research Center, Oslo, Norway
| | | | - Jon Olav Drogset
- Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Knee Ligament Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Stig Heir
- Martina Hansen Hospital, Baerum, Norway
| | - Lars Engebretsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Oslo Sports Trauma Research Center, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
| | | | - Håvard Visnes
- Oslo Sports Trauma Research Center, Oslo, Norway
- Norwegian Knee Ligament Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Hospital of Southern Norway, Kristiansand, Norway
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Heinz T, Oberfeld J, Luetkens KS, Anderson PM, Stratos I, Horas K, Bley TA, Rudert M, Reppenhagen S, Weißenberger M. The AMADEUS score is not a sufficient predictor for functional outcome after autologous chondrocyte implantation (ACI) of the knee: data from the German Cartilage Registry (KnorpelRegister DGOU). Arch Orthop Trauma Surg 2023; 143:7097-7105. [PMID: 37639044 PMCID: PMC10635975 DOI: 10.1007/s00402-023-05037-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION The AMADEUS (Area Measurement And DEpth and Underlying Structures) score has advanced to a commonly used tool for MRI-based chondral defect severity grading prior to cartilage knee surgery. It was the intention of this study to assess the AMADEUS for a potential correlation with clinical data by patient-reported outcome measures (PROMs). METHODS A total of 51 patients undergoing ACI (autologous chondrocyte implantation) between 2016 and 2022 were found eligible and retrospectively analyzed. All patients were registered in the German Cartilage Registry prior to surgery and follow-up data were collected using the Knee Osteoarthritis Outcome score (KOOS), the International Knee Documentation Committee (IKDC) Form and the numeric rating scale (NRS). Pre-operative MRI images were scored by three raters using the AMADEUS classification system, and an overall AMADEUS score was calculated which was subsequently correlated with pre- and post-operative PROMs. RESULTS Mean patient age was 32.67 ± 8.37 years and mean defect size area 343.04 mm2 ± 139.45 mm2. No correlative capacity of the pre- and postoperative IKDC, KOOS or NRS scores was found with the AMADEUS final score or any of its subscores. From the pre- to postoperative visit, a significant improvement of the PROMs (IKDC: 45.53 ± 21.00 vs. 59.83 ± 17.93, p = 0.04; KOOS Pain: 58.00 ± 16.70 vs. 76.06 ± 19.20, p = 0.03; KOOS ADL: 64.17 ± 18.76 vs. 82.11 ± 16.68, p < 0.01; KOOS Sports: 26.11 ± 18.52 vs. 50.56 ± 23.94, p = 0.01; KOOS QOL: 25.50 ± 14.26 ± 45.28 ± 19.03, p = 0.00) was found. Intraclass correlation coefficients showed an overall good interrater agreement for the AMADEUS total score (ICC = 0.75). CONCLUSIONS Study results suggest no correlative capacity of the AMADEUS with routinely used PROMs in patients undergoing ACI. Therefore, radiographically assessed cartilage defect characteristics poorly translate to pre- and postoperative patient-reported outcome data.
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Affiliation(s)
- Tizian Heinz
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Jan Oberfeld
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Karsten Sebastian Luetkens
- 2Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Germany
| | - Philip Mark Anderson
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Ioannis Stratos
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Konstantin Horas
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Thorsten Alexander Bley
- 2Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Germany
| | - Maximilian Rudert
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Stephan Reppenhagen
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany
| | - Manuel Weißenberger
- 1Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany.
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Kolin DA, Mackie AT, Heath MR, Uppstrom TJ, Green DW, Fabricant PD. No difference in patient reported outcomes between cohorts undergoing lesion-specific surgery for osteochondritis dissecans of the knee. J Orthop 2023; 37:22-26. [PMID: 36974089 PMCID: PMC10039298 DOI: 10.1016/j.jor.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/09/2023] Open
Abstract
Introduction There is a paucity of data on patient reported outcome measures (PROMs) associated with surgical treatment of osteochondritis dissecans (OCD). As a result, preoperative patient and family counseling regarding expected outcomes is difficult. The purpose of this study was to compare pre-to post-operative changes in PROMs amongst cohorts of patients with OCD that underwent one of three lesion-specific surgical treatments: 1) transarticular drilling for stable lesions, 2) drilling and fixation for unstable lesions 3) grafting for unsalvageable lesions. Methods The electronic medical records of pediatric and adolescent patients with knee OCD, at a single institution between January 2017 and August 2019, were reviewed. Patients were categorized into one of three surgical groups, with initial determination confirmed at the time of surgery during diagnostic knee arthroscopy. Differences between groups were assessed with one-way analysis of variance (ANOVA). Results Of the 78 patients included in this study, 49 (62.8%) were male with a mean age of 13.5 ± 2.2 years. There was no significant difference between the surgical groups for baseline HSS Pedi-FABS (P = 0.58) or PROMIS Mobility (P = 0.47). There were no significant differences in PROMIS PI scores at baseline (P = 0.32), at latest follow-up (P = 0.72), or in interval change from baseline to follow-up (P = 0.42), between the three surgical groups. Conclusion Lesion-specific surgical management of OCD led to similar improvements in PROMIS PI at a minimum of one-year follow-up. These results may better allow surgeons to reassure patients and families that outcomes are similar when lesions are treated through a lesion-specific algorithm. Level of evidence Level IV: Retrospective cohort study.
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Affiliation(s)
| | | | - Madison R. Heath
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Hoburg A, Niemeyer P, Laute V, Zinser W, Becher C, Kolombe T, Fay J, Pietsch S, Kuźma T, Widuchowski W, Fickert S. Sustained superiority in KOOS subscores after matrix-associated chondrocyte implantation using spheroids compared to microfracture. Knee Surg Sports Traumatol Arthrosc 2022; 31:2482-2493. [PMID: 36269383 DOI: 10.1007/s00167-022-07194-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of matrix-associated autologous chondrocyte implantation (ACI) using spheroids in comparison to arthroscopic microfracture for the treatment of symptomatic cartilage defects of the knee. METHODS In a prospective multicenter-controlled trial, patients aged between 18 and 50 years, with single symptomatic focal cartilage defects between 1 and 4 cm2 (mean 2.6 ± 0.8, median 2.75, range 1.44-5.00) in the knee were randomized to treatment with ACI with spheroids (n = 52) or microfracture (n = 50). Primary clinical outcome was assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS). Analyses were performed in a defined hierarchical manner where outcomes of ACI were first compared to baseline values followed by a comparison to the microfracture group with repeated-measures ANCOVA with a non-inferiority approach. Subgroup analyses were performed to investigate the influence of age and defect size on the overall KOOS. Secondary clinical outcomes were the magnetic resonance observation of cartilage repair tissue (MOCART), modified Lysholm score and International Knee Documentation Committee (IKDC) examination form. Safety data focused on adverse events. Here the 5 years results are presented at which there were 33 observed cases in the ACI group and 30 in the microfracture group. RESULTS The overall KOOS and its five subscores were significantly improved compared to baseline for both the ACI and microfracture group. Non-inferiority of ACI to microfracture was confirmed for the overall KOOS and the subscores, while for the subscores activities of daily living, quality of life and sports and recreation of the threshold for superiority was passed. In the ACI group, a notably more rapid initial improvement of the KOOS was found at three months for the older age group compared to the younger age group and the microfracture group. No other differences were found based on age or defect size. In addition, clinical improvement was found for the MOCART, modified Lysholm and IKDC examination form both the ACI and microfracture group. No safety concern related to either treatment was observed. CONCLUSION This study confirms the safety and efficacy of matrix-associated ACI with spheroids at a mid to long-term follow-up. Non-inferiority of ACI to microfracture was confirmed for the overall KOOS and all subscores, while superiority was reached for the subscores activities of daily living, quality of life and sports and recreation in the ACI group. This underlines the importance of ACI for the young and active patients. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Arnd Hoburg
- Med Center 360 degree Berlin, Kieler Straße 1, 12163, Berlin, Germany.
| | - Philipp Niemeyer
- Department of Orthopedic Surgery and Traumatology, University Hospital, Freiburg, Germany.,OCM Clinic, Munich, Germany
| | - Volker Laute
- Med Center 360 degree Berlin, Kieler Straße 1, 12163, Berlin, Germany
| | - Wolfgang Zinser
- Department of Orthopedic Surgery and Traumatology, St. Vinzenz-Hospital, Dinslaken, Germany
| | - Christoph Becher
- Department of Orthopedic Surgery, Medical University Annastift, Hannover, Germany
| | - Thomas Kolombe
- Traumatology and Reconstructive Surgery, DRK Hospital, Luckenwalde, Germany
| | - Jakob Fay
- Department of Traumatology and Arthroscopic Surgery, Lubinus Clinicum, Kiel, Germany
| | - Stefan Pietsch
- Department of Orthopedic Surgery and Traumatology, Rudolf Elle Hospital, Eisenberg, Germany
| | - Tomasz Kuźma
- Department of Orthopedic Surgery and Traumatology, Center of Sports Medicine, Orthopedic Clinic, Warsaw, Poland
| | | | - Stefan Fickert
- Sporthopaedicum Straubing, Straubing, Germany.,Department of Orthopedic Surgery and Traumatology, Medical Faculty Mannheim, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
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