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Microfracture Versus Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Knee: A Systematic Review of 5-Year Outcomes.
Am J Sports Med 2018; 46(4):995-999AJ

Abstract

BACKGROUND

Microfracture (MFx) and autologous chondrocyte implantation (ACI) are 2 surgical treatment options used to treat articular cartilage injuries of the knee joint.

PURPOSE

To compare the midterm to long-term clinical outcomes of MFx versus ACI for focal chondral defects of the knee.

STUDY DESIGN

Systematic review.

METHODS

A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to locate studies (level of evidence I-III) comparing the minimum average 5-year clinical outcomes of patients undergoing MFx versus ACI. Search terms used were "knee," "microfracture," "autologous chondrocyte implantation," and "autologous chondrocyte transplantation." Patients were evaluated based on treatment failure rates, magnetic resonance imaging, and patient-reported outcome scores (Lysholm, Knee Injury and Osteoarthritis Outcome Score [KOOS], and Tegner scores).

RESULTS

Five studies (3 level I evidence, 2 level II evidence) were identified that met the inclusion criteria, including a total of 210 patients (211 lesions) undergoing MFx and 189 patients (189 lesions) undergoing ACI. The average follow-up among all studies was 7.0 years. Four studies utilized first-generation, periosteum-based ACI (P-ACI), and 1 study utilized third-generation, matrix-associated ACI (M-ACI). Treatment failure occurred in 18.5% of patients undergoing ACI and 17.1% of patients undergoing MFx (P = .70). Lysholm and KOOS scores were found to improve for both groups across studies, without a significant difference in improvement between the groups. The only significant difference in patient-reported outcome scores was found in the 1 study using M-ACI in which Tegner scores improved to a significantly greater extent in the ACI group compared with the MFx group (P = .003).

CONCLUSION

Patients undergoing MFx or first/third-generation ACI for articular cartilage lesions in the knee can be expected to experience improvement in clinical outcomes at midterm to long-term follow-up without any significant difference between the groups.

Authors+Show Affiliations

CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA.CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA.CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA.CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA.

Pub Type(s)

Comparative Study
Journal Article
Systematic Review

Language

eng

PubMed ID

28423287

Citation

Kraeutler, Matthew J., et al. "Microfracture Versus Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Knee: a Systematic Review of 5-Year Outcomes." The American Journal of Sports Medicine, vol. 46, no. 4, 2018, pp. 995-999.
Kraeutler MJ, Belk JW, Purcell JM, et al. Microfracture Versus Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Knee: A Systematic Review of 5-Year Outcomes. Am J Sports Med. 2018;46(4):995-999.
Kraeutler, M. J., Belk, J. W., Purcell, J. M., & McCarty, E. C. (2018). Microfracture Versus Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Knee: A Systematic Review of 5-Year Outcomes. The American Journal of Sports Medicine, 46(4), pp. 995-999. doi:10.1177/0363546517701912.
Kraeutler MJ, et al. Microfracture Versus Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Knee: a Systematic Review of 5-Year Outcomes. Am J Sports Med. 2018;46(4):995-999. PubMed PMID: 28423287.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microfracture Versus Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Knee: A Systematic Review of 5-Year Outcomes. AU - Kraeutler,Matthew J, AU - Belk,John W, AU - Purcell,Justin M, AU - McCarty,Eric C, Y1 - 2017/04/19/ PY - 2017/4/20/pubmed PY - 2019/7/16/medline PY - 2017/4/20/entrez KW - articular cartilage KW - autologous chondrocyte implantation KW - focal chondral defects KW - microfracture SP - 995 EP - 999 JF - The American journal of sports medicine JO - Am J Sports Med VL - 46 IS - 4 N2 - BACKGROUND: Microfracture (MFx) and autologous chondrocyte implantation (ACI) are 2 surgical treatment options used to treat articular cartilage injuries of the knee joint. PURPOSE: To compare the midterm to long-term clinical outcomes of MFx versus ACI for focal chondral defects of the knee. STUDY DESIGN: Systematic review. METHODS: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to locate studies (level of evidence I-III) comparing the minimum average 5-year clinical outcomes of patients undergoing MFx versus ACI. Search terms used were "knee," "microfracture," "autologous chondrocyte implantation," and "autologous chondrocyte transplantation." Patients were evaluated based on treatment failure rates, magnetic resonance imaging, and patient-reported outcome scores (Lysholm, Knee Injury and Osteoarthritis Outcome Score [KOOS], and Tegner scores). RESULTS: Five studies (3 level I evidence, 2 level II evidence) were identified that met the inclusion criteria, including a total of 210 patients (211 lesions) undergoing MFx and 189 patients (189 lesions) undergoing ACI. The average follow-up among all studies was 7.0 years. Four studies utilized first-generation, periosteum-based ACI (P-ACI), and 1 study utilized third-generation, matrix-associated ACI (M-ACI). Treatment failure occurred in 18.5% of patients undergoing ACI and 17.1% of patients undergoing MFx (P = .70). Lysholm and KOOS scores were found to improve for both groups across studies, without a significant difference in improvement between the groups. The only significant difference in patient-reported outcome scores was found in the 1 study using M-ACI in which Tegner scores improved to a significantly greater extent in the ACI group compared with the MFx group (P = .003). CONCLUSION: Patients undergoing MFx or first/third-generation ACI for articular cartilage lesions in the knee can be expected to experience improvement in clinical outcomes at midterm to long-term follow-up without any significant difference between the groups. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/28423287/Microfracture_Versus_Autologous_Chondrocyte_Implantation_for_Articular_Cartilage_Lesions_in_the_Knee:_A_Systematic_Review_of_5_Year_Outcomes_ L2 - http://journals.sagepub.com/doi/full/10.1177/0363546517701912?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -