Autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, osteochondral autograft transplantation and osteochondral allograft improve knee function and pain with considerations for patient and cartilage defects characteristics: A systematic review and meta-analysis

IF 5 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-11-04 DOI:10.1002/ksa.12525

Joseph E. Nassar, Grace Guerin, Taidhgin Keel, Raffaella Russo, Filippo Familiari, Luke V. Tollefson, Robert F. LaPrade

{"title":"Autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, osteochondral autograft transplantation and osteochondral allograft improve knee function and pain with considerations for patient and cartilage defects characteristics: A systematic review and meta-analysis","authors":"Joseph E. Nassar, Grace Guerin, Taidhgin Keel, Raffaella Russo, Filippo Familiari, Luke V. Tollefson, Robert F. LaPrade","doi":"10.1002/ksa.12525","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>Previous studies have reported on the outcomes of autologous chondrocyte implantation (ACI) versus matrix-induced ACI (MACI) and microfracture. Specific clinical outcomes of ACI, MACI, osteochondral autograft transplantation (OAT) and osteochondral allograft (OCA) have not been well studied. The purpose of this systematic review and meta-analysis was to analyze the outcomes of these regenerative surgical techniques with an emphasis on comparing their effectiveness using the International Knee Documentation Committee (IKDC) subjective score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and the Visual Analogue Scale (VAS) score for the surgical treatment of tibiofemoral joint cartilage defects.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>An electronic search of MEDLINE, Embase and Cochrane Library was performed to identify studies that reported clinical outcomes for ACI, MACI, OAT and OCA procedures. The literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and only studies involving cartilage defects in the tibiofemoral joint were included. Outcomes were measured with the IKDC evaluation, Lysholm Knee Scoring Scale, Tegner Activity Scale and the VAS. Outcomes were compared to the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). The methodological quality of the included studies was analyzed by the Methodological Index for Nonrandomized Studies and the Jadad scale.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Forty-seven studies were included representing a total of 1993 patients with a mean follow-up time of 57.2 ± 40.3 months (range: 4.0–160.0 months). The location of cartilage defects was reported in 46 studies, with a total of 1922 cartilage defects. There were 1277 medial femoral condyle cartilage defects, 488 lateral femoral condyle cartilage defects, 139 unspecified femoral condyle cartilage defects and 18 tibial plateau cartilage defects. All four procedures reported significant improvements in the Lysholm, IKDC, Tegner and VAS scores with no significant differences between them. The OAT technique surpassed the PASS threshold for the IKDC score while all four techniques surpassed the PASS threshold for Tegner and Lysholm scores. Additionally, all procedures met the MCID for each clinical outcome.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>This systematic review and meta-analysis indicate that ACI, MACI, OAT and OCA all result in significant improvements in knee function and pain for cartilage defects of the tibiofemoral joint. When selecting a procedure, patient and cartilage defect characteristics should be assessed to determine the best technique for each individual patient.</p>\n </section>\n \n <section>\n \n <h3> Study Design</h3>\n \n <p>Systematic review and meta-analysis.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level III.</p>\n </section>\n </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"2745-2762"},"PeriodicalIF":5.0000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12525","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee Surgery, Sports Traumatology, Arthroscopy","FirstCategoryId":"3","ListUrlMain":"https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/ksa.12525","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

Previous studies have reported on the outcomes of autologous chondrocyte implantation (ACI) versus matrix-induced ACI (MACI) and microfracture. Specific clinical outcomes of ACI, MACI, osteochondral autograft transplantation (OAT) and osteochondral allograft (OCA) have not been well studied. The purpose of this systematic review and meta-analysis was to analyze the outcomes of these regenerative surgical techniques with an emphasis on comparing their effectiveness using the International Knee Documentation Committee (IKDC) subjective score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and the Visual Analogue Scale (VAS) score for the surgical treatment of tibiofemoral joint cartilage defects.

Methods

An electronic search of MEDLINE, Embase and Cochrane Library was performed to identify studies that reported clinical outcomes for ACI, MACI, OAT and OCA procedures. The literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and only studies involving cartilage defects in the tibiofemoral joint were included. Outcomes were measured with the IKDC evaluation, Lysholm Knee Scoring Scale, Tegner Activity Scale and the VAS. Outcomes were compared to the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). The methodological quality of the included studies was analyzed by the Methodological Index for Nonrandomized Studies and the Jadad scale.

Results

Forty-seven studies were included representing a total of 1993 patients with a mean follow-up time of 57.2 ± 40.3 months (range: 4.0–160.0 months). The location of cartilage defects was reported in 46 studies, with a total of 1922 cartilage defects. There were 1277 medial femoral condyle cartilage defects, 488 lateral femoral condyle cartilage defects, 139 unspecified femoral condyle cartilage defects and 18 tibial plateau cartilage defects. All four procedures reported significant improvements in the Lysholm, IKDC, Tegner and VAS scores with no significant differences between them. The OAT technique surpassed the PASS threshold for the IKDC score while all four techniques surpassed the PASS threshold for Tegner and Lysholm scores. Additionally, all procedures met the MCID for each clinical outcome.

Conclusion

This systematic review and meta-analysis indicate that ACI, MACI, OAT and OCA all result in significant improvements in knee function and pain for cartilage defects of the tibiofemoral joint. When selecting a procedure, patient and cartilage defect characteristics should be assessed to determine the best technique for each individual patient.

Study Design

Systematic review and meta-analysis.

Level of Evidence

Level III.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

自体软骨细胞植入、基质诱导自体软骨细胞植入、骨软骨自体移植和骨软骨异体移植可改善膝关节功能和疼痛，并考虑患者和软骨缺损特征：系统综述和荟萃分析。

目的：以往的研究报告了自体软骨细胞植入（ACI）与基质诱导 ACI（MACI）和微骨折的疗效对比。ACI、MACI、骨软骨自体移植（OAT）和骨软骨异体移植（OCA）的具体临床疗效尚未得到充分研究。本系统综述和荟萃分析的目的是分析这些再生手术技术的疗效，重点是比较国际膝关节文献委员会（IKDC）主观评分、Lysholm 膝关节评分量表、Tegner 活动量表和视觉模拟量表（VAS）评分对胫股关节软骨缺损手术治疗的效果：对 MEDLINE、Embase 和 Cochrane 图书馆进行电子检索，以确定报告 ACI、MACI、OAT 和 OCA 手术临床结果的研究。文献综述按照《系统综述和元分析首选报告项目》指南进行，仅纳入涉及胫股关节软骨缺损的研究。研究结果通过 IKDC 评估、Lysholm 膝关节评分量表、Tegner 活动量表和 VAS 进行测量。研究结果与最小临床意义差异（MCID）和患者可接受症状状态（PASS）进行了比较。纳入研究的方法学质量采用非随机研究方法学指数和贾达德量表进行分析：结果：47 项研究共纳入 1993 名患者，平均随访时间为 57.2 ± 40.3 个月（范围：4.0-160.0 个月）。46项研究报告了软骨缺损的位置，共有1922处软骨缺损。其中股骨内侧髁软骨缺损1277例，股骨外侧髁软骨缺损488例，不明股骨髁软骨缺损139例，胫骨平台软骨缺损18例。所有四种手术的 Lysholm、IKDC、Tegner 和 VAS 评分均有明显改善，且无明显差异。OAT 技术的 IKDC 评分超过了 PASS 临界值，而所有四种技术的 Tegner 和 Lysholm 评分都超过了 PASS 临界值。此外，所有程序的每项临床结果都达到了 MCID：本系统综述和荟萃分析表明，ACI、MACI、OAT 和 OCA 均可显著改善胫股关节软骨缺损患者的膝关节功能和疼痛。在选择手术时，应评估患者和软骨缺损的特征，以确定最适合每位患者的技术：系统综述和荟萃分析：证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).