Article
Matrix augmented bone marrow stimulation using a polyglycolic acid membrane with hyaluronan vs. microfracture alone in local femoral cartilage defects of the femoral condyles: a multicenter randomized controlled trial
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Authors
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Johannes Glasbrenner
- Universitätsklinikum Münster, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Münster, Germany
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Wolf Petersen
- Martin-Luther-Krankenhaus Berlin, Berlin, Germany
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Michael J. Raschke
- Universitätsklinikum Münster, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Münster, Germany
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Matthias Steiger
- Universitätsklinikum Münster, Institut für klinische Radiologie, Münster, Germany
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René Verdonk
- Ghent University Hospital, Gent, Belgium
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Claudio Castelli
- Azienda Ospedaliera Papa Giovanni XXIII Bergamo, Bergamo, Italy
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Daniel Fritschy
- Geneva University Hospital, Geneva, Switzerland
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Mirco Herbort
- OCM Klinik München, München, Germany
| Published: | October 22, 2019 |
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Outline
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Objectives: Microfracture (MF) is the gold standard for the treatment of small localized chondral defects of the knee joint. There is evidence from animal studies that the augmentation of bone marrow stimulation by a matrix improves the quality of the repair tissue (matrix augmented bone marrow stimulation = m-BMS). Aim of this randomized controlled trial (RCT) was to examine the outcome of a matrix made of polyglycolic acid and hyaluronan in comparison to a conventional MF technique.
Methods: In a multicenter RCT patients between 18-60 years with an articular femoral cartilage defect of 1-4 cm2 in the weight bearing area of the femoral condyles with indication for MF were enrolled and randomized to MF alone or m-BMS using a polyglycolic acid membrane with hyaluronan. At 12, 54 and 108 weeks after surgery a MRI scan was performed and patient reported clinical outcome scores (VAS pain, KOOS, IKDC and SF-36) were obtained.
Results and conclusion: There was no statistically significant difference between both groups in the clinical outcome scores or the defect filling obtained by MRI. Nevertheless, there was an advantage for the m-BMS group in terms of improvement over time in the KOOS subscales pain, knee-related symptoms, activity of daily living, sports and recreation and quality of life at 54 weeks and 108 weeks after treatment.
This is the first RCT comparing m-BMS using a polyglycolic acid membrane with hyaluronan to any different treatment strategy in localized cartilage defects of any human joint. The results of this study support the hypothesis, that in local femoral cartilage defects of up to 4cm2 of size m-BMS provides an advantage in terms of lasting defect filling and clinical outcome at two years postoperatively compared to MF. These results should be reaffirmed by long term follow up studies.
