Main Article Content
Derangements of various metabolic processes leads to a high prevalence of insidious chondral defects which may predispose patients to osteoarthritis. This may lead to deterioration of the quality of life in physical, psychological and social domains. Though, autologous chondrocyte implantation (ACI) yields superior results in chondral defects as compared to microfractures, there has been no meta-analysis till date to quantify the clinical efficacy of various chondrocyte implantation techniques as compared to each other. Our review will synthesize current evidence to establish the superior technique for chondral knee defects in terms of clinical outcomes and post-operative quality of life.
An exhaustive search will be undertaken on PubMed, Cochrane, Embase, International Clinical Trials Registry Platform (ICTRP), Trip Medical Database and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to identify relevant studies. Primary human studies comparing matrix-associated chondrocyte implantation and autologous chondrocyte implantation in the context of knee chondral defects would be included. The primary outcome will be postoperative improvement in knee functions assessed clinically or via activity scores like International Knee Documentation Committee (IKDC) subjective score, Lysholm-Gillquist score and Tegner Activity Score. The secondary outcomes will be radiological scores for monitoring structural improvement like Magnetic Resonance Observation of Cartilage Repair Tissue score and health-related quality of life scores.
This will be the first systematic review and meta-analysis in available literature comparing the clinical outcomes and post-operative quality of life in these patients and can be expected to guide clinical practice in chondral defects of the knee.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
© Journal of Asian Medical Students’ Association (JAMSA). Released under a Creative Commons license.
Delafontaine A, Fourcade P, Honeine JL et al. Postural adaptations to unilateral knee joint hypomobility induced by orthosis wear during gait initiation. Sci Rep 8, 830 (2018). https://doi.org/10.1038/s41598-018-19151-1
Kim HY, Kim KJ, Yang DS et al. Screw-Home Movement of the Tibiofemoral Joint during Normal Gait: Three-Dimensional Analysis. Clin Orthop Surg. 2015 Sep;7(3):303-9. https://doi.org/10.4055/cios.2015.7.3.303
Akkiraju H, Nohe A. Role of Chondrocytes in Cartilage Formation, Progression of Osteoarthritis and Cartilage Regeneration. J Dev Biol. 2015;3(4):177-192. https://doi.org/10.3390/jdb3040177
Houck DA, Kraeutler MJ, Belk JW et al. Do Focal Chondral Defects of the Knee Increase the Risk for Progression to Osteoarthritis? A Review of the Literature. Orthop J Sports Med. 2018 Oct 18;6(10):2325967118801931. https://doi.org/10.1177/2325967118801931
Migliorini F, Eschweiler J, Schenker, H et al. Surgical management of focal chondral defects of the knee: a Bayesian network meta-analysis. J Orthop Surg Res 16, 543 (2021). https://doi.org/10.1186/s13018-021-02684-z
Flanigan DC, Harris JD, Trinh TQ et al. Prevalence of chondral defects in athletes' knees: a systematic review. Med Sci Sports Exerc. 2010 Oct;42(10):1795-801. https://doi.org/10.1249/MSS.0b013e3181d9eea0
Camp CL, Stuart MJ, Krych AJ. Current concepts of articular cartilage restoration techniques in the knee Sports Health. 2014;6(3):265-273 https://doi.org/10.1177/1941738113508917
Xie F, Kovic B, Jin X et al. Economic and Humanistic Burden of Osteoarthritis: A Systematic Review of Large Sample Studies. PharmacoEconomics 34, 1087–1100 (2016).
Fuggle NR, Cooper C, Oreffo ROC, et al. Alternative and complementary therapies in osteoarthritis and cartilage repair. Aging Clin Exp Res. 2020;32(4):547-560. https://doi.org/10.1007/s40520-020-01515-1
Gobbi A, Karnatzikos G, Kumar A. Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes. Knee Surg Sports Traumatol Arthrosc. 2014 Sep;22(9):1986-96.
Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001;(391 Suppl):S362-9.
Koh Y-G, Kwon O-R, Kim Y-S, Choi Y-J, Tak D-H. Adipose-derived mesenchymal stem cells with microfracture versus microfracture alone: 2-year follow-up of a prospective randomized trial. Arthroscopy. 2016;32(1):97-109.
Siclari A, Mascaro G, Gentili C, Kaps C, Cancedda R, Boux E. Cartilage repair in the knee with subchondral drilling augmented with a platelet-rich plasma-immersed polymer-based implant. Knee Surg Sport Traumatol Arthrosc. 2013;22(6):1225-34.
Strauss E, Schachter A, Frenkel S, Rosen J. The efficacy of intra-articular hyaluronan injection after the microfracture technique for the treatment of articular cartilage lesions. Am J Sports Med. 2009;37(4):720-6.
Saris D, Price A, Widuchowski W, Bertrand-Marchand M, Caron J, Drogset JO, Emans P, Podskubka A, Tsuchida A, Kili S, Levine D, Brittberg M; SUMMIT study group. Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture: Two-Year Follow-up of a Prospective Randomized Trial. Am J Sports Med. 2014 Jun;42(6):1384-94. https://doi.org/10.1177/0363546514528093
Bachmann G, Basad E, Lommel D, Steinmeyer J. Die MRT in der Verlaufskontrolle nach matrixgestützer autologer Chondrozytenimplantation (MACI) und Mikrofrakturierung [MRI in the follow-up of matrix-supported autologous chondrocyte transplantation (MACI) and microfracture]. Radiologe. 2004 Aug;44(8):773-82. German. https://doi.org/10.1007/s00117-004-1084-y.
Brittberg M, Lindahl A, Nillson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994;331:889-95.
Tuan RS. A second-generation autologous chondrocyte implantation approach to the treatment of focal articular cartilage defects. Arthritis Res Ther 2007; 9:109 https://doi.org/10.1186/ar2310
Zeifang F, Oberle D, Nierhoff C, Richter W, Moradi, B, Schmitt, H. (2010). Autologous Chondrocyte Implantation Using the Original Periosteum-Cover Technique Versus Matrix-Associated Autologous Chondrocyte Implantation: A Randomized Clinical Trial. 38(5), 924–933. https://doi.org/10.1177/0363546509351499
The Cochrane Collaboration. Data extraction forms. Cochrane Developmental, Psychosocial and Learning Problems. https://dplp.cochrane.org/data-extraction-forms. Published 2014. Accessed February 6, 2022.
Bedi A, Feeley BT, Williams RJ 3rd. Management of articular cartilage defects of the knee. J Bone Joint Surg Am. 2010 Apr;92(4):994-1009. https://doi.org/10.2106/JBJS.I.00895