title: Mid-term results of Autologous Matrix-Induced Chondrogenesis for treatment of focal cartilage defects in the knee.
abstract: Articular cartilage defects heal poorly. Autologous Matrix-Induced Chondrogenesis (AMIC) is an innovative treatment for localized full-thickness cartilage defects combining the well-known microfracturing with collagen scaffold and fibrin glue. The purpose of this prospective study was to evaluate the medium-term results of this enhanced microfracture technique for the treatment of chondral lesions of the knee. Thirty-two chondral lesions in 27 patients were treated with AMIC. Within the context of clinical follow-up, these patients were evaluated for up to 5 years after the intervention. Five different scores (Meyer score, Tegner score, Lysholm score, ICRS score, Cincinnati score) as well as radiographs were used for outcome analysis. Articular resurfacing was assessed by magnetic resonance imaging (MRI). The average age of patients (11 females, 16 males; mean body mass index 26, range 20-32) was 37 years (range 16-50 years). The mean defect size of the chondral lesions was 4.2 cm(2) (range 1.3-8.8 cm(2)). All defects were classified as grade IV according to the Outerbridge classification. The follow-up period was between 24 and 62 months with a mean of 37 months. Twenty out of 23 individuals (87%) questioned were subjectively highly satisfied with the results after surgery. Significant improvement (P < 0.05) of all scores was observed as early as 12 months after AMIC, and further increased values were notable up to 24 months postoperatively. MRI analysis showed moderate to complete filling with a normal to incidentally hyperintense signal in most cases. Results did not show a clinical impact of patient's age at the time of operation, body mass index and number of previous operations (n.s.). In contrast, males showed significant higher values in the ICRS score compared to their female counterparts. AMIC is an effective and safe method of treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases. However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time.
authors.affiliation: Department of Orthopaedics and Trauma, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck, Germany. Justus_gille@usa.net
authors.forename: J
authors.initials: J
authors.lastname: Gille
authors.forename: E
authors.initials: E
authors.lastname: Schuseil
authors.forename: J
authors.initials: J
authors.lastname: Wimmer
authors.forename: J
authors.initials: J
authors.lastname: Gellissen
authors.forename: A P
authors.initials: AP
authors.lastname: Schulz
authors.forename: P
authors.initials: P
authors.lastname: Behrens
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D054544:Arthroplasty, Subchondral; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery*; D019902:Chondrocytes / Q000637:transplantation; D020219:Chondrogenesis / Q000502:physiology*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007718:Knee Injuries / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D023822:Tissue Engineering / Q000379:methods; D054457:Tissue Scaffolds; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015718:Fibrin Tissue Adhesive