title: Matrix-induced autologous mesenchymal stem cell implantation versus matrix-induced autologous chondrocyte implantation in the treatment of chondral defects of the knee: a 2-year randomized study.
abstract: BACKGROUND
  Cell-based strategies that combine in vitro- expanded autologous chondrocytes with matrix scaffolds are currently preferred for full-thickness cartilage lesions of the knee ≥2 cm(2). Although this approach is reasonable, continuing advances in the field of cartilage repair will further expand the options available to improve outcomes.
  
  
  OBJECTIVE
  In the present clinical study, we compared the outcomes of matrix-induced autologous mesenchymal stem cell implantation (m-AMI) with matrix-induced autologous chondrocyte implantation (m-ACI) for the treatment of isolated chondral defects of the knee.
  
  
  METHODS
  Prospective, single-site, randomized, single-blind pilot study.
  
  
  METHODS
  Fourteen patients with isolated full-thickness chondral lesions of the knee >2 cm(2) were randomized into two treatment groups: m-AMI and m-ACI. Outcomes were assessed pre-operatively and 3, 6, 12 and 24 months post-operatively.
  
  
  RESULTS
  Clinical evaluations revealed that improvement from pre-operation to 24 months post-operation occurred in both groups (p < 0.05). At all follow-up intervals, m-AMI demonstrated significantly better functional outcomes (motion deficit and straight leg raise strength) than did m-ACI (p < 0.05). At all follow-up intervals, m-AMI demonstrated significantly better subjective sub-scale scores for pain, symptoms, activities of daily living and sport and recreation of the knee injury and osteoarthritis outcome score (KOOS) than did m-ACI (p < 0.05). Additionally, m-AMI demonstrated significantly better (p < 0.05) scores than m-ACI for the quality of life sub-scale of the KOOS and visual analog scale (VAS) severity at the 6-month follow-up. The Tegner activity score and VAS frequency were not significantly different between the two groups. Graft failure was not observed on magnetic resonance imaging at the 24-month follow-up. m-AMI and m-ACI demonstrated very good-to-excellent and good-to-very good infill, respectively, with no adverse effects from the implant, regardless of the treatment.
  
  
  CONCLUSIONS
  For the treatment of isolated full-thickness chondral lesion of the knee, m-AMI can be used effectively and may potentially accelerate recovery. A larger patient cohort and follow-up supported by histological analyses are necessary to determine long-term outcomes.
authors.affiliation: Department of Orthopaedics and Traumatology, Cactus Healthcare, Istanbul, Turkey.
authors.forename: Isık
authors.initials: I
authors.lastname: Akgun
authors.affiliation: Department of Orthopedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul University, 34303, Kocamustafapasa, Istanbul, Turkey. unludilek@hotmail.com.
authors.forename: Mehmet C
authors.initials: MC
authors.lastname: Unlu
authors.affiliation: Department of Orthopedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul University, 34303, Kocamustafapasa, Istanbul, Turkey.
authors.forename: Ozan A
authors.initials: OA
authors.lastname: Erdal
authors.affiliation: Department of Orthopedics and Traumatology, Cerrahpasa Medical Faculty, Istanbul University, 34303, Kocamustafapasa, Istanbul, Turkey.
authors.forename: Tahir
authors.initials: T
authors.lastname: Ogut
authors.affiliation: Department of Medical Microbiology, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Erturk
authors.affiliation: Labcell, Istanbul, Turkey.
authors.forename: Ercument
authors.initials: E
authors.lastname: Ovali
authors.affiliation: Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Kantarci
authors.affiliation: Department of Orthopedics and Traumatology, Kanuni Sultan Suleyman State Hospital, Istanbul, Turkey.
authors.forename: Gurkan
authors.initials: G
authors.lastname: Caliskan
authors.affiliation: Genetics and Molecular Biologist, Cellular Biologist, Trinity School of Medicine, Atlanta, USA.
authors.forename: Yamac
authors.initials: Y
authors.lastname: Akgun
mesh_terms: D000293:Adolescent; D000328:Adult; D002356:Cartilage / Q000637:transplantation; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery*; D019902:Chondrocytes / Q000637:transplantation*; D005109:Extracellular Matrix / Q000637:transplantation; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D016037:Single-Blind Method; D054457:Tissue Scaffolds; D014182:Transplantation, Autologous; D055815:Young Adult