What did the study look at?
Joint cartilage has a limited ability to repair itself. MACI is a third-generation autologous chondrocyte implantation (cartilage cell transplantation) method in which the patient's own cartilage cells are grown in the laboratory, seeded onto a collagen membrane (matrix) and implanted into the damaged area. The study aimed to examine the results of MACI for osteochondral lesions (involving cartilage and the underlying bone) of the knee and the factors affecting functional outcomes.
How was it done?
- Thirty-four patients (30 men, 4 women; mean age 30.4 ± 9.3 years) treated with MACI by the same surgeon between 2010 and 2016 were assessed retrospectively.
- In the first session, a 200-300 mg cartilage sample was taken arthroscopically; in the second, the laboratory-grown cells were implanted through a small open incision (mini-arthrotomy).
- The mean defect size was 5.4 ± 1.4 cm² and the mean follow-up 22.8 ± 11.1 months. Fifteen patients (44.1%) had associated problems such as ACL reconstruction, meniscal treatment or corrective osteotomy.
- Function was measured with the Lysholm and Modified Cincinnati knee scores; results were compared by sex, body mass index (BMI) and associated problems.
What did it find?
- The mean Lysholm score rose from 37.2 before surgery to 73.9 at 6 months, 80.6 at 12 months and 84.9 at 24 months (18 patients). The Cincinnati score rose from 37.7 to 74.4, 80.9 and 85.8. The increase was statistically significant at all follow-ups (p = 0.0001).
- No significant difference was found between patients with a BMI of 25 or below and those above 25 (p = 0.941 and p = 0.779).
- The 19 patients without associated problems scored significantly higher at 6 and 12 months than the 15 with associated problems (for example, Lysholm 84.9 versus 74.6 at 12 months; p = 0.0001). After 24 months there was no significant difference.
- Because there were only 4 women, no statistical comparison by sex was made.
- Fewer patients reached the later follow-ups: 9 at 36 months, 2 at 48 months and 1 at 60 months.
The authors' conclusion
The authors conclude that MACI provides good and stable results for focal cartilage damage in young patients. To achieve the desired results, they state that appropriate patients must be selected and associated problems must be taken into account.
Limitations
The authors note that the number of patients was relatively small and that the level of evidence could be raised by future randomised studies. There were too few women for statistical analysis, and other factors such as age, defect location and symptom duration need to be studied in larger series.
Reference
Gürsoy S, Akkaya M, Şimşek ME, Gürsoy M, Doğan M, Bozkurt M. (2019). Factors Influencing the Results in Matrix-Associated Autologous Chondrocyte Implantation: A 2 - 5 Year Follow-Up Study. Journal of Clinical Medicine Research, 11(2), 137–144. Licence: CC BY-NC 4.0.
DOI: 10.14740/jocmr3711
Free full text: PMC6340672
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
