Long-term clinical follow-up of microfracture versus mosaicplasty in articular cartilage defects of medial femoral condyle

The Knee ◽  
2017 ◽  
Vol 24 (6) ◽  
pp. 1402-1407 ◽  
Author(s):  
Eirik Solheim ◽  
Janne Hegna ◽  
Eivind Inderhaug
Keyword(s):  
Articular Cartilage ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Cartilage Defects ◽  
Articular Cartilage Defects

scholarly journals Autologous chondrocyte implantation in the knee: systematic review and economic evaluation

2017 ◽  
Vol 21 (6) ◽  
pp. 1-294 ◽  
Author(s):  
Hema Mistry ◽  
Martin Connock ◽  
Joshua Pink ◽  
Deepson Shyangdan ◽  
Christine Clar ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Observational Studies ◽  
Health Technology ◽  
Long Term Results ◽  
Cartilage Defects ◽  
Chondrocyte Implantation ◽  
Articular Cartilage Defects ◽  
Autologous Chondrocyte

BackgroundThe surfaces of the bones in the knee are covered with articular cartilage, a rubber-like substance that is very smooth, allowing frictionless movement in the joint and acting as a shock absorber. The cells that form the cartilage are called chondrocytes. Natural cartilage is called hyaline cartilage. Articular cartilage has very little capacity for self-repair, so damage may be permanent. Various methods have been used to try to repair cartilage. Autologous chondrocyte implantation (ACI) involves laboratory culture of cartilage-producing cells from the knee and then implanting them into the chondral defect.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of ACI in chondral defects in the knee, compared with microfracture (MF).Data sourcesA broad search was done in MEDLINE, EMBASE, The Cochrane Library, NHS Economic Evaluation Database and Web of Science, for studies published since the last Health Technology Assessment review.Review methodsSystematic review of recent reviews, trials, long-term observational studies and economic evaluations of the use of ACI and MF for repairing symptomatic articular cartilage defects of the knee. A new economic model was constructed. Submissions from two manufacturers and the ACTIVE (Autologous Chondrocyte Transplantation/Implantation Versus Existing Treatment) trial group were reviewed. Survival analysis was based on long-term observational studies.ResultsFour randomised controlled trials (RCTs) published since the last appraisal provided evidence on the efficacy of ACI. The SUMMIT (Superiority of Matrix-induced autologous chondrocyte implant versus Microfracture for Treatment of symptomatic articular cartilage defects) trial compared matrix-applied chondrocyte implantation (MACI®) against MF. The TIG/ACT/01/2000 (TIG/ACT) trial compared ACI with characterised chondrocytes against MF. The ACTIVE trial compared several forms of ACI against standard treatments, mainly MF. In the SUMMIT trial, improvements in knee injury and osteoarthritis outcome scores (KOOSs), and the proportion of responders, were greater in the MACI group than in the MF group. In the TIG/ACT trial there was improvement in the KOOS at 60 months, but no difference between ACI and MF overall. Patients with onset of symptoms < 3 years’ duration did better with ACI. Results from ACTIVE have not yet been published. Survival analysis suggests that long-term results are better with ACI than with MF. Economic modelling suggested that ACI was cost-effective compared with MF across a range of scenarios.LimitationsThe main limitation is the lack of RCT data beyond 5 years of follow-up. A second is that the techniques of ACI are evolving, so long-term data come from trials using forms of ACI that are now superseded. In the modelling, we therefore assumed that durability of cartilage repair as seen in studies of older forms of ACI could be applied in modelling of newer forms. A third is that the high list prices of chondrocytes are reduced by confidential discounting. The main research needs are for longer-term follow-up and for trials of the next generation of ACI.ConclusionsThe evidence base for ACI has improved since the last appraisal by the National Institute for Health and Care Excellence. In most analyses, the incremental cost-effectiveness ratios for ACI compared with MF appear to be within a range usually considered acceptable. Research is needed into long-term results of new forms of ACI.Study registrationThis study is registered as PROSPERO CRD42014013083.FundingThe National Institute for Health Research Health Technology Assessment programme.

Randomized Study of Long-term (15-17 Years) Outcome After Microfracture Versus Mosaicplasty in Knee Articular Cartilage Defects

2017 ◽  
Vol 46 (4) ◽  
pp. 826-831 ◽  
Author(s):  
Eirik Solheim ◽  
Janne Hegna ◽  
Torbjørn Strand ◽  
Thomas Harlem ◽  
Eivind Inderhaug
Keyword(s):  
Articular Cartilage ◽  
Controlled Trial ◽  
Randomized Study ◽  
Lysholm Score ◽  
Outcome Variable ◽  
Cartilage Defects ◽  
Level Of Evidence ◽  
Articular Cartilage Defects

Background: Few comparative randomized long-term studies on microfracture versus mosaicplasty have been published, and only 2 studies reported a follow-up of 10 years. Hypothesis/Purpose: The purpose was to compare the clinical outcome of microfracture versus mosaicplasty/osteochondral autograft transfer in symptomatic cartilage lesions. The null hypothesis was that the outcome was not statistically different at any point of time. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Forty patients with articular cartilage defects were randomized to undergo cartilage repair by either microfracture (n = 20) or mosaicplasty (n = 20). Inclusion criteria were as follows: age 18 to 50 years at the time of surgery, 1 or 2 symptomatic focal full-thickness articular chondral defects on the femoral condyles or trochlea, and size 2 to 6 cm2. The main outcome variable was the Lysholm knee score recorded before the surgery and at 12 months, median 5 years, median 10 years, and minimum 15 years after the surgery. Results: Forty patients were included in the study (28 men, 12 women; median age, 32 years; range, 18-48 years). Defects with a median size of 3.5 cm2 (range, 2-5 cm2) were treated. A significant increase in the Lysholm score was seen for all subjects— from a mean 53 (SD, 16) at baseline to 69 (SD, 21) at the minimum 15-year follow-up ( P = .001). The mean Lysholm score was significantly higher in the mosaicplasty group than the microfracture group at 12 months, median 5 years, median 10 years, and minimum 15 years: 77 (SD, 17) versus 61 (SD, 22), respectively ( P = .01), at the last follow-up. At all follow-up time points, the difference in mean Lysholm score was clinically significant (>10 points). Conclusion: At short, medium, and long term (minimum 15 years), mosaicplasty results in a better, clinically relevant outcome than microfracture in articular cartilage defects (2-5 cm2) of the distal femur of the knee in patients aged 18 to 50 years.

scholarly journals Autologous Costal Cartilage Graft—A New Method to Treat Articular Cartilage Defects: Case Report and Note of Surgical Technique

Joints ◽  
2018 ◽  
Vol 06 (04) ◽  
pp. 246-250
Author(s):  
Antonio Gigante ◽  
Marco Cianforlini ◽  
Luca Farinelli ◽  
Riccardo Girotto ◽  
Alberto Aquili
Keyword(s):  
Articular Cartilage ◽  
Femoral Condyle ◽  
Costal Cartilage ◽  
Donor Site ◽  
Standard Technique ◽  
Cartilage Defects ◽  
Cartilage Graft ◽  
Full Thickness ◽  
Articular Cartilage Defects ◽  
Costal Cartilage Graft

AbstractFull-thickness articular cartilage defects do not heal spontaneously. Several techniques have been developed to address this issue, but none resulted in the restitutio ad integrum of the articular cartilage. The most frequent sites of chondral lesion in the knee are medial femoral condyle and patella. The patellofemoral lesions are characterized by outcomes that are generally worse than those of tibiofemoral ones. To date, it has been well recognized the chondrogenic potential of rib perichondrium, and costal cartilage grafts have been extensively used in reconstructive surgery. Considering the need to find a gold standard technique to restore articular defect, we developed and here described a new technique to repair cartilage lesions of the knee using autologous costal cartilage graft with its perichondrium. This innovative surgical approach can be used to treat full thickness articular defects using autologous hyaline cartilage, making it possible to cover wide defects. This one step technique is low invasive, not technically demanding with minimal donor site morbidity and it has low costs. The long-term clinical efficacy of the method remains to be evaluated.

scholarly journals Cell-Free Osteochondral Scaffold for the Treatment of Focal Articular Cartilage Defects in Early Knee OA: 5 Years’ Follow-Up Results

2019 ◽  
Vol 8 (11) ◽  
pp. 1978 ◽  
Author(s):  
Andrea Sessa ◽  
Luca Andriolo ◽  
Alessandro Di Martino ◽  
Iacopo Romandini ◽  
Roberto De Filippis ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
International Knee Documentation Committee ◽  
Clinical Results ◽  
Activity Level ◽  
Cartilage Defects ◽  
Mri Findings ◽  
Clinical Criteria ◽  
Osteochondral Scaffold ◽  
Articular Cartilage Defects

The purpose of this study was to investigate the clinical results at five years’ follow-up of a tri-layered nanostructured biomimetic osteochondral scaffold used for focal articular cartilage defects in patients meeting the criteria of early osteoarthritis (EOA). The study population comprised 22 patients (mean age: 39 years), prospectively assessed before surgery, at 24 and 60 months’ follow-up. Inclusion criteria were: at least two episodes of knee pain for more than 10 days in the last year, Kellgren-Lawrence OA grade 0, I or II and arthroscopic or MRI findings according to the European Society of Sports Traumatology, Knee Surgery & Arthroscopy (ESSKA) criteria. Clinical results demonstrated significant improvement in International Knee Documentation Committee (IKDC) subjective and objective scores and in Tegner score, although activity level never reached the pre-injury level. The complication rate of this study was 8.3%. Two patients underwent re-operation (8.3%), while a comprehensive definition of failure (including both surgical and clinical criteria) identified four failed patients (16.6%) at this mid-term follow-up evaluation. The use of a free-cell osteochondral scaffold represented a safe and valid alternative for the treatment of focal articular cartilage defects in the setting of an EOA, and was able to permit a significant clinical improvement and stable outcome with low complication and failure rates.

scholarly journals The long-term results of meniscus transplantation for articular cartilage defects in the knee joint

2006 ◽  
Vol 15 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Masataka Deie ◽  
Yoshio Sumen ◽  
Nobuo Adachi ◽  
Atsuo Nakamae ◽  
Ayato Miyamoto ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Knee Joint ◽  
Long Term Results ◽  
Cartilage Defects ◽  
Meniscus Transplantation ◽  
Articular Cartilage Defects

Paper #1 Full-thickness articular cartilage defects of the trochlea: long-term patient outcomes at 4–6 years

2003 ◽  
Vol 19 (6) ◽  
pp. 1
Author(s):  
Jon E Browne ◽  
Freddie H Fu ◽  
Robert A Arciero ◽  
Christoph Erggelet ◽  
Lyle J Micheli ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Patient Outcomes ◽  
Cartilage Defects ◽  
Full Thickness ◽  
Articular Cartilage Defects
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