title: Treatment of Full-Thickness Chondral Defects With Hyalograft C in the Knee: Long-term Results.
abstract: BACKGROUND
  Matrix-associated autologous chondrocyte transplantation (MACT) has become an established articular cartilage repair technique. It provides good short-term and midterm results; however, long-term results are lacking.
  
  
  OBJECTIVE
  To prospectively assess the clinical outcome after MACT in the knee to report long-term results.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Fifty-three subjects (females/males, 22/31; mean age, 32 ± 12 years) were treated between 2000 and 2006 with a hyaluronan-based MACT product and were followed prospectively. The mean body mass index (BMI) was 24.5 ± 3.8 kg/m(2) and the mean defect size was 4.4 ± 1.9 cm(2). Fifty patients had single defects and 3 had multiple defects (41 medial femoral condyle, 6 lateral femoral condyle, 2 patella, 1 tibia). Two patients had 2 defects (medial femoral condyle [MFC]/lateral femoral condyle and tibial/MFC), and in 1 case, multiple defects on the MFC were treated. The patients were stratified into 23 "simple," 22 "complex," and 8 "salvage" cases. Instability or malalignment was treated before or at the time of graft implantation. For 6 patients with small defects (<2 cm(2)), microfracturing was used as first-line treatment before MACT. Clinical assessment was performed once a year with the subjective and objective International Knee Documentation Committee (IKDC) scores, Lysholm score, and a modified Cincinnati Knee Rating System.
  
  
  RESULTS
  The mean follow-up time was 9.07 ± 2.9 years (range, 5-12 years). Treatment failure occurred in 12 of 53 cases (22.6%) an average of 2.99 ± 1.40 years after surgery. There was 1 failure (4.3%) among the simple cases, 4 failures (18.2%) in complex cases, and 7 failures (87.5%) in salvage cases. Statistically significant increases were observed in all scores at all time points compared with presurgery levels (P < .05). The subjective IKDC score improved from median 40.4 preoperatively to 74.7 at 10-year follow-up (n = 13 patients; P < .05).
  
  
  CONCLUSIONS
  MACT is an excellent surgical therapy for full-thickness cartilage defects of the knee, with good long-term results for simple defects. However, it should not be used in salvage cases.
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Vienna, Austria martin.brix@meduniwien.ac.at.
authors.forename: Martin O
authors.initials: MO
authors.lastname: Brix
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Vienna, Austria.
authors.forename: David
authors.initials: D
authors.lastname: Stelzeneder
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Vienna, Austria.
authors.forename: Catharina
authors.initials: C
authors.lastname: Chiari
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Vienna, Austria.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Koller
authors.affiliation: Danube University Krems, Krems, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Nehrer
authors.affiliation: Orthopaedic City Center, Vienna, Austria.
authors.forename: Ronald
authors.initials: R
authors.lastname: Dorotka
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Vienna, Austria.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Windhager
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Vienna, Austria Orthopaedic Rehabilitation Center SKA Zicksee, St Andrä am Zicksee, Austria.
authors.forename: Stephan E
authors.initials: SE
authors.lastname: Domayer
mesh_terms: D000328:Adult; D002358:Cartilage, Articular / Q000293:injuries* / Q000601:surgery; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014182:Transplantation, Autologous
chemical_list: D006820:Hyaluronic Acid
keywords: Hyalograft C; MACT; knee; long-term