Skip to main content
SpringerLink
Log in

Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Cartilage defects occur in approximately 12% of the population and can result in significant function impairment and reduction in quality of life. Evidence for the variety of surgical treatments available is inconclusive. This study aimed to compare the clinical outcomes of patients with symptomatic cartilage defects treated with matrix-induced autologous chondrocyte implantation (MACI™ or microfracture (MF). Included patients were ≥18 and ≤50 years of age with symptomatic, post-traumatic, single, isolated chondral defects (4–10 cm2) and were randomised to receive MACI™ or MF. Patients were followed up 8–12, 22–26 and 50–54 weeks post-operatively for efficacy and safety evaluation. Outcome measures were the Tegner, Lysholm and ICRS scores. Sixty patients were included in a randomised study (40 MACI™, 20 MF). The difference between baseline and 24 months post-operatively for both treatment groups was significant for the Lysholm, Tegner, patient ICRS and surgeon ICRS scores (all P < 0.0001). However, MACI™ was significantly more effective over time (24 months versus baseline) than MF according to the Lysholm (P = 0.005), Tegner (P = 0.04), ICRS patient (P = 0.03) and ICRS surgeon (P = 0.02) scores. There were no safety issues related to MACI™ or MF during the study. MACI™ is superior to MF in the treatment of articular defects over 2 years. MACI™ and MF are complementary procedures, depending on the size of the defect and symptom recurrence. The MACI™ technique represents a significant advance over both first and second generation chondrocyte-based cartilage repair techniques for surgeons, patients, health care institutions and payers in terms of reproducibility, safety, intraoperative time, surgical simplicity and reduced invasiveness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Abelow SP, Guillen P, Ramos T (2006) Arthroscopic technique for matrix-induced autologous chondrocyte implantation for the treatment of large chondral defects in the knee and ankle. Oper Tech Orthop 16:257–261

    Article  Google Scholar 

  2. Aroen A, Loken S, Heir S, Alvik E, Ekeland A, Granlund OG, Engebretsen L (2004) Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med 32:211–215

    Article  PubMed  Google Scholar 

  3. Bachmann G, Basad E, Lommel D, Steinmeyer J (2004) MRI in the follow-up of matrix-supported autologous chondrocyte transplantation (MACI™) and microfracture. Radiologe 44:773–782

    Article  CAS  PubMed  Google Scholar 

  4. Bartlett W, Krishnan SP, Skinner JA, Carrington RWJ, Briggs TWR, Bentley G (2006) Collagen-covered versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a comparison of tourniquet times. Eur J Orthop Surg Traumatol 16:315–317

    Article  Google Scholar 

  5. Bartlett W, Skinner JA, Gooding CR, Carrington RW, Flanagan AM, Briggs TW, Bentley G (2005) Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee. J Bone Joint Surg (Br) 87-B:640–645

    Google Scholar 

  6. Basad E, Stürz H, Steinmeyer J (2007) Treatment of osteochondral defects of the knee with autologous bone graft and chondrocyte transplantation: an overview together with our results. Acta Orthop Traumatol Turc 41(Suppl 2):79–86

    PubMed  Google Scholar 

  7. Bates D, Maechler M (2008) Matrix: sparse and dense matrix classes and methods. R package version 0.999375-16. http://cran.r-project.org/

  8. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331:889–895

    Article  CAS  PubMed  Google Scholar 

  9. Brunner E, Langer F (2000) Nonparametric analysis of ordered categorical data in designs with longitudinal observations and small sample sizes. Biom J 42(6):663–675

    Article  Google Scholar 

  10. Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13:456–460

    CAS  PubMed  Google Scholar 

  11. Davies-Tuck ML, Wluka AE, Wang Y, English DR, Giles GG, Cicuttini FM (2008) The natural history of cartilage defects in people with knee osteoarthritis. Osteoarthr Cartil 16:337–342

    Article  CAS  PubMed  Google Scholar 

  12. Gooding CR, Bartlett W, Bentley G, Skinner JA, Carrington R, Flanagan A (2006) A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: periosteum covered versus type I/III collagen covered. Knee 13:203–210

    Article  CAS  PubMed  Google Scholar 

  13. Grana WA (2000) Healing of articular cartilage: a review. Am J Knee Surg 13:29–32

    CAS  PubMed  Google Scholar 

  14. Hambly K, Bobic V, Wondrasch B, Van Assche D, Marlovits S (2006) Autologous chondrocyte implantation postoperative care and rehabilitation: science and practice. Am J Sports Med 34:1020–1038

    Article  PubMed  Google Scholar 

  15. Hangody L, Vásárhelyi G, Hangody LR, Sükösd Z, Tibay G, Bartha L, Bodó G (2008) Autologous osteochondral grafting—technique and long-term results. Injury 39(Suppl 1):S32–S39

    Article  PubMed  Google Scholar 

  16. Hjelle K, Solheim E, Strand T, Muri R, Brittberg M (2002) Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 18:730–734

    Article  PubMed  Google Scholar 

  17. Horas U, Pelinkovic D, Herr G, Aigner T, Schnettler R (2003) Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial. J Bone Joint Surg Am 85-A:185–192

    CAS  PubMed  Google Scholar 

  18. ICRS Cartilage Injury Evaluation Package (2000) The International Cartilage Repair Society web site: http://www.cartilage.org/_files/contentmanagement/ICRS_evaluation.pdf. Accessed 28th September 2009

  19. Jagiello MJ, Rogers B, Briggs TWR (2007) Sequential outcome improvement following autologous chondrocyte implantation—7 year follow-up Podium presentation (no. 182) at the 2007 American Academy of Orthopaedic Surgeons, 14th–18th February, San Diego, USA

  20. Jakobsen RB, Engebretsen L, Slauterbeck JR (2005) An analysis of the quality of cartilage repair studies. J Bone Joint Surg Am 87:2232–2239

    Article  PubMed  Google Scholar 

  21. Knutsen G, Drogset JO, Engebretsen L, Grøntvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 89:2105–2112

    Article  PubMed  Google Scholar 

  22. Knutsen G, Engebretsen L, Ludvigsen T, Drogset JO, Grøntvedt T, Solheim E, Strand T, Roberts S, Isaksen V, Johansen O (2004) Autologous chondrocyte implantation compared with microfracture in the knee: a randomized trial. J Bone Joint Surg Am 86:455–464

    PubMed  Google Scholar 

  23. Lysholm J, Gillquist J (1982) Evaluation of the knee ligament results with special emphasis on the use of a scoring scale. J Am Sports Med 3:150–153

    Article  Google Scholar 

  24. Marlovits S, Striessnig G, Kutscha-Lissberg F, Resinger C, Aldrian SM, Vécsei V, Trattnig S (2005) Early post-operative adherence of matrix-induced autologous chondrocyte implantation for the treatment of full-thickness cartilage defects of the femoral condyle. Knee Surg Sports Traumatol Arthrosc 13:451–457

    Article  PubMed  Google Scholar 

  25. Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T (2009) Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med 37:902–908 (epub 2009 Mar 4)

    Article  PubMed  Google Scholar 

  26. Peterson L, Minas T, Brittberg M, Nilsson A, Sjögren-Jansson E, Lindahl A (2000) Two to nine year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res 374:212–234

    Article  PubMed  Google Scholar 

  27. R Development Core Team (2008) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0, http://www.r-project.org

  28. Saris DB, Vanlauwe J, Victor J, Haspl M, Bohnsack M, Fortems Y, Vandekerckhove B, Almqvist KF, Claes T, Handelberg F, Lagae K, van der Bauwhede J, Vandenneucker H, Yang KG, Jelic M, Verdonk R, Veulemans N, Bellemans J, Luyten FP (2008) Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med 36:235–246

    Article  PubMed  Google Scholar 

  29. Sellards RA, Nho SJ, Cole BJ (2002) Chondral injuries. Curr Opin Rheumatol 14:134–141

    Article  PubMed  Google Scholar 

  30. Steadman JR, Rodkey WG, Briggs KK (2002) Microfracture to treat full-thickness chondral defects: surgical technique, rehabilitation, and outcomes. J Knee Surg 15:170–176

    PubMed  Google Scholar 

  31. Steadman JR, Rodkey WG, Briggs KK, Rodrigo JJ (1999) The microfracture technique in the management of complete cartilage defects in the knee joint. Orthopade 28:26–32

    CAS  PubMed  Google Scholar 

  32. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  33. Venables WN, Ripley BD (2003) Modern applied statistics with S. Springer, New York. ISBN 978-0387954578

  34. Zheng MH, Willers C, Kirilak L, Yates P, Xu J, Wood D, Shimmin A (2007) Matrix-induced autologous chondrocyte implantation (MACI™©): biological and histological assessment. Tissue Eng 13:737–746

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Dr. Gerrit Eichner for his assistance with the statistical analysis.

Author information

Authors and Affiliations

  1. Clinic and Polyclinic for Orthopaedic Surgery, University Hospital Giessen-Marburg GmbH, Paul-Meimberg-Strasse 3, 35392, Giessen, Germany

    Erhan Basad, Bernd Ishaque, Henning Stürz & Jürgen Steinmeyer

  2. Department of Diagnostic Radiology, Kerckhoff Clinic, Bad Nauheim, Germany

    Georg Bachmann

Authors
  1. Erhan Basad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bernd Ishaque
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Georg Bachmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Henning Stürz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jürgen Steinmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erhan Basad.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Basad, E., Ishaque, B., Bachmann, G. et al. Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study. Knee Surg Sports Traumatol Arthrosc 18, 519–527 (2010). https://doi.org/10.1007/s00167-009-1028-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-009-1028-1

Keywords

Search

Navigation