title: Clinical and radiological long-term outcomes after matrix-induced autologous chondrocyte transplantation: a prospective follow-up at a minimum of 10 years.
abstract: BACKGROUND
  It is unclear whether matrix-associated autologous chondrocyte transplantation (MACT) results in objective and subjective clinical improvements at 10 years after surgery.
  
  
  OBJECTIVE
  Matrix-associated autologous chondrocyte transplantation will result in clinical and radiological improvements in patients with symptomatic, traumatic chondral defects of the knee joint.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  A total of 16 patients with chondral defects of the knee were treated with MACT between November 2000 and April 2002 and evaluated for up to 10 years after the intervention. The International Knee Documentation Committee (IKDC) form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner activity score, Brittberg score, Noyes sports activity rating scale, and visual analog scale (VAS) for pain as well as 3-T magnetic resonance imaging (MRI) using the magnetic resonance observation of cartilage repair tissue (MOCART) score and functional evaluation by the limb symmetry index (LSI) formed the basis of this study. The Friedman test and the Wilcoxon signed-rank test were performed for a comparison between all time points and 2 separate time points, respectively. If significant differences were revealed, a Bonferroni adjustment to the α level was applied so that P values <.007 (<.05/7) were regarded as significant in the paired comparisons.
  
  
  RESULTS
  Significant improvements (P < .05) from baseline to 120 months postoperatively were observed for the IKDC score (mean, 44.1 ± 26.9 to 59.0 ± 27.4), Noyes sports activity rating score (mean, 37.7 ± 30.1 to 62.1 ± 31.3), and KOOS Quality of Life and Pain subscores, whereas no statistically significant improvement was detected for the Brittberg score, Tegner activity score, or VAS score. After 5 years, a slight downward tendency of all clinical scores was evident. After 10 years, the mean MOCART score was 70.4 ± 16.1. Complete filling of the defect was observed in 73.9% of cases, and osteophytes were present in 78.3%. In 65.2% of the cases, a subchondral bone edema <1 cm was visible, whereas in 21.7% of the cases, a subchondral bone edema >1 cm was seen. The mean LSI for the single-legged hop test was 95.6% ± 16.2% and for the triple hop test for distance was 91.3% ± 12.2%. The mean VAS score for self-perceived stability was 60.2 ± 3.5 (range, 0-9.5) for the injured and 60.7 ± 3.8 (range, 0-10) for the uninjured leg. No adhesions or effusions were seen regarding the clinical and radiological outcomes.
  
  
  CONCLUSIONS
  The significantly improved results on 3 outcome measures after 10 years suggest that MACT represents a suitable option in the treatment of local cartilage defects in the knee.
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria silke.aldrian@meduniwien.ac.at.
authors.forename: Silke
authors.initials: S
authors.lastname: Aldrian
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Lukas
authors.initials: L
authors.lastname: Zak
authors.affiliation: Department of Health & Social Sciences, St Pölten University of Applied Sciences, St Pölten, Austria Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wondrasch
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Albrecht
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Beate
authors.initials: B
authors.lastname: Stelzeneder
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Harald
authors.initials: H
authors.lastname: Binder
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Kovar
authors.affiliation: Department of Radiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Trattnig
authors.affiliation: Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Marlovits
mesh_terms: D000328:Adult; D054544:Arthroplasty, Subchondral; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery*; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D059352:Musculoskeletal Pain; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D019233:Retreatment; D054457:Tissue Scaffolds; D014182:Transplantation, Autologous; D055815:Young Adult
keywords: MACT; cartilage; knee; long-term outcome