Article
Treatment of focal chondral defects in the knee with AMIC or hand-minced cartilage: A matched-patients analysis
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Authors
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Peter Behrendt
- Klinik für Orthopädie und Unfallchirurgie, UKSH, Campus Kiel, Anatomisches Institut, Christian-Albrechts-Universität Kiel, Kiel, Germany
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Lena Eggeling
- BG Klinikum Hamburg, Abteilung Unfallchirurgie, Orthopädie und Sporttraumatologie, Hamburg, Germany
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Fidelius von Rehlingen-Prinz
- UKE, Hamburg, Germany
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Matthias Krause
- Klinik für Unfallchirurgie und Orthopädie, UKE, Hamburg, Hamburg, Germany
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Michael Hoffmann
- Asklepios Klinikum St. Georg, Hamburg, Germany
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Karl-Heinz Frosch
- Uniklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Hamburg, Germany
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Ralph Akoto
- BG Klinikum Hamburg, Hamburg, Germany
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Justus Gille
- Orthopaedic and Trauma Surgery, Regio Kliniken, Pinneberg, Germany
| Published: | October 21, 2024 |
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Outline
Text
Objectives: Focal chondral defects have been increasing in incidence, with a high probability of early onset of osteoarthritis if left untreated. While several surgical options are in clinical use, direct comparisons of different treatment methods are scarce. We conducted a matched-patient analysis of patient reported outcome measures (PROMs) to compare 2 surgical treatment methods: hand-minced autologous cartilage (MC) versus Autologous Matrix-Induced Chondrogenesis (AMIC).
Methods: Data from 2 surgical centers were used for this analysis. At 1 centre, patients were treated with a 1-stage procedure in which autologous cartilage was hand-minced using a scalpel, implanted into the defect, and fixed with fibrin glue. At the 2nd centre, patients underwent AMIC, in which bone marrow stimulation was performed and the site was covered with a collagen I/III bilayer membrane (Chondro-Gide, Geistlich) which was fixed in place with fibrin glue. All patients were seen 2 – 4 years post-operatively. Patients were matched by age, sex, defect size and defect localization. Post-operative outcomes were assessed using the Visual Analog Scale for pain (VAS), the Lysholm score and the 5 domains of the Knee Osteoarthritis Outcome Score (KOOS).
Results and conclusion: Patient demographics at baseline are shown below. The groups did not differ in age or defect size (Table 1 [Tab. 1]). Comparison of PROMs revealed that patients who had been treated with AMIC exhibited better scores compared to the patients who had been treated with MC. In terms of positive responders, more AMIC -treated patients exceeded the Patient Acceptable Symptom State for Lysholm (70 points) at the time of follow up (Table 2 [Tab. 2]).
The results indicate that AMIC delivers better patient outcomes, as evidenced by improved scores in Lysholm, VAS and 4 of the 5 KOOS sub-domains than hand-minced autologous cartilage.While these are essentially short-term outcomes, with follow-up between 2- and 4-years status post, other published data indicate that these positive outcomes are likely to continue at longer -term. Therefore, longer follow-up of these matched patients will provide useful clinical data to surgeons who treat focal chondral defects.
