title: Outcomes after a single-stage procedure for cell-based cartilage repair: a prospective clinical safety trial with 2-year follow-up.
abstract: BACKGROUND
  There are currently several approaches being pursued to treat focal defects of articular cartilage, each having specific advantages or challenges. A single-stage procedure that uses autologous cartilage fragments, Cartilage Autograft Implantation System (CAIS), is being evaluated in patients and may offer a clinically effective option.
  
  
  OBJECTIVE
  To establish the safety of CAIS and to test whether CAIS improves quality of life by using standardized outcomes assessment tools.
  
  
  METHODS
  Randomized controlled trial; Level of evidence, 2.
  
  
  METHODS
  Patients (n = 29) were randomized (1:2) with the intent to treat with either a control (microfracture [MFX]) or an experimental (CAIS) procedure. Patients were followed at predetermined time points for 2 years using several standardized outcomes assessment tools (SF-36, International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS]). Magnetic resonance imaging was performed at baseline, 3 weeks, and 6, 12, and 24 months.
  
  
  RESULTS
  Lesion size and International Cartilage Repair Society (ICRS) grade were similar in both groups. General outcome measures (eg, physical component score of the SF-36) indicated an overall improvement in both groups, and no differences in the number of adverse effects were noted in comparisons between the CAIS and MFX groups. The IKDC score of the CAIS group was significantly higher (73.9 ± 14.72 at 12 months and 82.95 ± 14.88 at 24 months) compared with the MFX group (57.78 ± 18.31 at 12 months and 59.5 ± 13.44 at 24 months). Select subdomains (4/5) in the KOOS instrument were significantly different at 12 and 18 months, and all subdomains (Symptoms and Stiffness, Pain, Activities of Daily Living, Sports and Recreation, Knee-related Quality of Life) were significantly increased at 24 months in CAIS with scores of 88.47 ± 11.68, 90.64 ± 7.87, 97.29 ± 3.8, 78.16 ± 22.06, and 69 ± 23.15 compared with 75 ± 9.31, 78.94 ± 13.73, 89.46 ± 8.13, 51.67 ± 26.01, and 37.15 ± 21.67 in the MFX group. These significant improvements were maintained at 24 months in both IKDC and KOOS. Qualitative analysis of the imaging data did not note differences between the 2 groups in fill of the graft bed, tissue integration, or presence of subchondral cysts. Patients treated with MFX had a significantly higher incidence of intralesional osteophyte formation (54% and 70% of total number of lesions treated) at 6 and 12 months when compared with CAIS (8% and 25% of total number of lesions treated).
  
  
  CONCLUSIONS
  The first clinical experience in using CAIS for treating patients with focal chondral defects indicates that it is a safe, feasible, and effective method that may improve long-term clinical outcomes.
authors: Brian J. Cole, Midwest Orthopaedics, Chicago, IL 60612, USA. bcole@rushortho.com
authors: Brian J
authors: BJ
authors: Cole
authors: Jack
authors: J
authors: Farr
authors: C S
authors: CS
authors: Winalski
authors: Timothy
authors: T
authors: Hosea
authors: John
authors: J
authors: Richmond
authors: Bert
authors: B
authors: Mandelbaum
authors: Patrick G
authors: PG
authors: De Deyne
mesh_terms: D000328:Adult; D054544:Arthroplasty, Subchondral; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D051457:Hyaline Cartilage / Q000637:transplantation*; D007718:Knee Injuries / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult