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Autologous chondrocyte implantation using the original periosteum-cover technique versus matrix-associated autologous chondrocyte implantation: a randomized clinical trial.

Abstract

BACKGROUND

Autologous chondrocyte implantation (ACI) is frequently used to treat symptomatic defects of the articular cartilage.

PURPOSE

To test whether matrix-associated autologous chondrocyte implantation or the original periosteal flap technique provides superior outcomes in terms of clinical efficacy and safety.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 2.

METHODS

Twenty-one patients (mean age, 29.3 +/- 9.1 years) with symptomatic isolated full-thickness cartilage defects (mean 4.1 +/- 09 cm2) at the femoral condyle were randomized to matrix-associated autologous chondrocyte implantation or the original periosteal flap technique. The primary outcome parameter was the postoperative change in knee function as assessed by the International Knee Documentation Committee (IKDC) score at 12 months after ACI. In addition, the IKDC score was assessed at 3, 6, 12, and 24 months after surgery. Secondary outcome parameters were postoperative changes in health related quality of life (Short Form-36 Health Survey), knee functionality (Lysholm and Gillquist score), and physical activity (Tegner Activity Score) at 3, 6, 12, and 24 months after ACI. Magnetic resonance imaging was performed to evaluate the cartilage 6, 12, and 24 months after ACI and rated using the Magnetic Resonance Observation of Cartilage Repair Tissue score. Adverse events were recorded to assess safety.

RESULTS

The primary outcome parameter showed improvement of patients 1 year after autologous chondrocyte implantation, but there was no difference between the periosteal flap technique and matrix-associated ACI (P = .5573); 2 years after ACI, a similar result was found (P = .4994). The study groups did not show differences in the Short Form-36 categories and in knee functionality as assessed by Tegner Activity Score 12 months (P = .4063) and 24 months (P = .1043) after ACI. There was a significant difference in the Lysholm and Gillquist score at 12 months (P = .0449) and 24 months (P = .0487) favoring the periosteal flap technique group. At 6 months after surgery, a significantly lower Magnetic Resonance Observation of Cartilage Repair score was obtained in the matrix-associated ACI group (P = .0123), corresponding to more normal magnetic resonance imaging diagnostic findings. Twelve and 24 months after ACI, the differences between the 2 groups were not significant (12 months, P = .2065; 24 months, P = .6926). Adverse events were related to knee problems such as transplant delamination, development of an osseous spur, osteochondral dissection, and transplant hypertrophy. Systemic (allergic, toxic, or autoimmune) reactions did not occur.

CONCLUSION

There was no difference in the efficacy between the original and the advanced ACI technique 12 and 24 months after surgery regarding International Knee Documentation Committee, Tegner Activity Score, and Short Form-36; however, with respect to the Lysholm and Gillquist score, better efficacy was observed in the periosteal flap technique group.

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  • Authors+Show Affiliations

    ,

    Orthopädische Universitätsklinik Heidelberg, Heidelberg, Germany. felix.zeifang@ok.uni-heidelberg.de

    , , , ,

    Source

    MeSH

    Adolescent
    Adult
    Cartilage, Articular
    Chondrocytes
    Female
    Humans
    Joint Instability
    Knee Injuries
    Male
    Middle Aged
    Motor Activity
    Orthopedic Procedures
    Periosteum
    Quality of Life
    Range of Motion, Articular
    Reconstructive Surgical Procedures
    Tissue Scaffolds
    Transplantation, Autologous
    Treatment Outcome
    Young Adult

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    19966102

    Citation

    Zeifang, Felix, et al. "Autologous Chondrocyte Implantation Using the Original Periosteum-cover Technique Versus Matrix-associated Autologous Chondrocyte Implantation: a Randomized Clinical Trial." The American Journal of Sports Medicine, vol. 38, no. 5, 2010, pp. 924-33.
    Zeifang F, Oberle D, Nierhoff C, et al. Autologous chondrocyte implantation using the original periosteum-cover technique versus matrix-associated autologous chondrocyte implantation: a randomized clinical trial. Am J Sports Med. 2010;38(5):924-33.
    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. The American Journal of Sports Medicine, 38(5), pp. 924-33. doi:10.1177/0363546509351499.
    Zeifang F, et al. Autologous Chondrocyte Implantation Using the Original Periosteum-cover Technique Versus Matrix-associated Autologous Chondrocyte Implantation: a Randomized Clinical Trial. Am J Sports Med. 2010;38(5):924-33. PubMed PMID: 19966102.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Autologous chondrocyte implantation using the original periosteum-cover technique versus matrix-associated autologous chondrocyte implantation: a randomized clinical trial. AU - Zeifang,Felix, AU - Oberle,Doris, AU - Nierhoff,Corinna, AU - Richter,Wiltrud, AU - Moradi,Babak, AU - Schmitt,Holger, Y1 - 2009/12/04/ PY - 2009/12/8/entrez PY - 2009/12/8/pubmed PY - 2010/7/30/medline SP - 924 EP - 33 JF - The American journal of sports medicine JO - Am J Sports Med VL - 38 IS - 5 N2 - BACKGROUND: Autologous chondrocyte implantation (ACI) is frequently used to treat symptomatic defects of the articular cartilage. PURPOSE: To test whether matrix-associated autologous chondrocyte implantation or the original periosteal flap technique provides superior outcomes in terms of clinical efficacy and safety. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS: Twenty-one patients (mean age, 29.3 +/- 9.1 years) with symptomatic isolated full-thickness cartilage defects (mean 4.1 +/- 09 cm2) at the femoral condyle were randomized to matrix-associated autologous chondrocyte implantation or the original periosteal flap technique. The primary outcome parameter was the postoperative change in knee function as assessed by the International Knee Documentation Committee (IKDC) score at 12 months after ACI. In addition, the IKDC score was assessed at 3, 6, 12, and 24 months after surgery. Secondary outcome parameters were postoperative changes in health related quality of life (Short Form-36 Health Survey), knee functionality (Lysholm and Gillquist score), and physical activity (Tegner Activity Score) at 3, 6, 12, and 24 months after ACI. Magnetic resonance imaging was performed to evaluate the cartilage 6, 12, and 24 months after ACI and rated using the Magnetic Resonance Observation of Cartilage Repair Tissue score. Adverse events were recorded to assess safety. RESULTS: The primary outcome parameter showed improvement of patients 1 year after autologous chondrocyte implantation, but there was no difference between the periosteal flap technique and matrix-associated ACI (P = .5573); 2 years after ACI, a similar result was found (P = .4994). The study groups did not show differences in the Short Form-36 categories and in knee functionality as assessed by Tegner Activity Score 12 months (P = .4063) and 24 months (P = .1043) after ACI. There was a significant difference in the Lysholm and Gillquist score at 12 months (P = .0449) and 24 months (P = .0487) favoring the periosteal flap technique group. At 6 months after surgery, a significantly lower Magnetic Resonance Observation of Cartilage Repair score was obtained in the matrix-associated ACI group (P = .0123), corresponding to more normal magnetic resonance imaging diagnostic findings. Twelve and 24 months after ACI, the differences between the 2 groups were not significant (12 months, P = .2065; 24 months, P = .6926). Adverse events were related to knee problems such as transplant delamination, development of an osseous spur, osteochondral dissection, and transplant hypertrophy. Systemic (allergic, toxic, or autoimmune) reactions did not occur. CONCLUSION: There was no difference in the efficacy between the original and the advanced ACI technique 12 and 24 months after surgery regarding International Knee Documentation Committee, Tegner Activity Score, and Short Form-36; however, with respect to the Lysholm and Gillquist score, better efficacy was observed in the periosteal flap technique group. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/19966102/Autologous_chondrocyte_implantation_using_the_original_periosteum_cover_technique_versus_matrix_associated_autologous_chondrocyte_implantation:_a_randomized_clinical_trial_ L2 - http://journals.sagepub.com/doi/full/10.1177/0363546509351499?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -