Summary
Good to excellent PROMS and MOCART preliminary scores after the combined treatment prove that regenerative cartilage medicine is a valid option for active adults and needs further applicability in the orthopedic field
Abstract
Background
Articular cartilage repair remains one of the most challenging issues for regenerative medicine in orthopaedics. The golden standard for cartilage repair remains matrix-induced autologous chondrocyte implantation (MACI) as the cartilage resulting has the most similar structure to the native hyaline cartilage. However, it is a two-stages surgery, expensive and can cause donor site morbidity.
Purpose
This study focuses on clinical and radiological outcomes in patients treated for focal cartilage lesions with a combination of collagen osseocartilaginous inducing tri-layer scaffold and a chondroprogenitor suspension of auricular cells obtained through Autologous Micrografting Technology (AMT).
Methods
A retrospective matched paired comparative study was conducted. Inclusion criteria were: adults with grade IV focal chondral lesions of the knee on MRI. Exclusion criteria were: signs of OA in all three knee compartments, rheumatoid / autoimmune systematic diseases, non- compliance to follow up (FU) and rehab protocol. Two groups of 10 patients each were formed: the AMT group and the control group. The control group consisted in patients treated solely with either the tri-layer scaffold and /or microfractures. All patients completed KOOS, KOOS Jr, IKCD, EQ-5D-5L, MARX scale at fixed intervals after surgery. MOCART score was assessed for cartilage healing at final follow-up. Descriptive and comparative statistical analysis were conducted accordingly.
Results
At an average of 11 months after surgery only 7 patients completed their follow-up. Analysis was conducted as per 'intention to treat' (ITT) model. Clinical outcomes improved significantly at final follow-up in both group (p<0.01) with no significant differences between groups. MOCART score showed a trend favoring defect filling, structure and integration in the AMT group. No correlations with demographic data were found.
Conclusion
Surgeons should not be afraid in using the latest technologies when it comes to cartilage repair. This study shows at least a favorable trend in using implants embedded with chondroprogenitor suspension of auricular cells obtained, which ultimately can lead to higher quality of quality in active adults and to prolonging the need for arthroplasty.