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Enhanced microfracture using acellular scaffolds improves results after treatment of symptomatic focal grade III/IV knee cartilage lesions but current clinical evidence does not allow unequivocal recommendation

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To systematically analyse post-operative outcomes following enhanced microfracture procedures in focal cartilage injuries of the knee.

Methods

Database searches were conducted in PubMed, EMBASE and Cochrane Library databases up to 30 November 2018, for clinical studies in humans that assessed surgical outcomes of enhanced microfracture procedures in focal cartilage injuries of the knee. The clinical, functional and imaging outcomes were assessed and summarized. The MINORS scale was used to assess the methodological quality of the studies included.

Results

Ten studies were included comprising a total of 331 patients (mean age of 37.0 ± 5.5 years, body mass 25.2 ± 1.7 kg m2, 56% male and 42% left knee), 278 femoral condyle chondral defects (147 medial, 35 lateral and 78 undefined) and 43 chondral defects distributed by the tibial plateau, patella and femoral trochlea. The chondral defects were mostly Outerbridge grade III or IV and the mean defect size was 3.2 ± 0.6 cm2. Studies consistently demonstrated significant improvement in the patient-reported outcome measures from baseline to final follow-up. Overall, imaging outcomes showed inconsistent results. Treatment-related adverse events were poorly reported.

Conclusion

Enhanced microfracture techniques significantly result in improved patient-reported outcome measures over the MCID, but provide inconsistent imaging results. Current clinical evidence does not allow for unequivocal recommendation of enhanced microfracture to treat symptomatic focal grade III/IV knee cartilage lesions.

Level of evidence

IV.

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Abbreviations

MFX:

Microfracture

MCID:

Minimal clinically important difference

AMIC:

The autologous matrix-induced chondrogenesis

CS:

Chondroitin sulphate

MRI:

Magnetic resonance imaging

MOCART:

Magnetic Resonance Observation of Cartilage Repair Tissue

IKDC:

International Knee Documentation Committee Subjective Knee Form

WOMAC:

Western Ontario and McMaster Universities Arthritis Index

KOOS:

Knee Injury and Osteoarthritis Outcome Score

VAS:

Visual Analogue Scale

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Funding

The authors declare that there was no funding for this study.

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Authors and Affiliations

  1. Stemmatters, Biotecnologia e Medicina Regenerativa SA, Parque de Ciência e Tecnologia Avepark, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal

    Cristiana Branco da Cunha, Tiago Rafael Veloso, David A. Learmonth & Rui A. Sousa

  2. Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal

    Renato Andrade & João Espregueira-Mendes

  3. Dom Henrique Research Centre, Porto, Portugal

    Renato Andrade & João Espregueira-Mendes

  4. Faculty of Sports, University of Porto, Porto, Portugal

    Renato Andrade

  5. ICVS/3B’s-PT Government Associate Laboratory, Braga/Guimarães, Portugal

    João Espregueira-Mendes

  6. Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal

    João Espregueira-Mendes

Authors
  1. Cristiana Branco da Cunha
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  2. Renato Andrade
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  3. Tiago Rafael Veloso
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  4. David A. Learmonth
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  5. João Espregueira-Mendes
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Contributions

CBC, TRV and RA designed and implemented the systematic review protocol, CBC, TRV and RA collected, analyzed and interpreted the data collected, CBC, TRV and RA critically reviewed the scientific content of the manuscript, CBC, RA, JEM and RAS drafted the manuscript, and all authors (CBC, RA, TRV, DAL, JEM and RAS) have read, reviewed and given final approval for the version to be published.

Corresponding author

Correspondence to Cristiana Branco da Cunha.

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Conflict of interest

JEM and RAS are shareholders, and CBC, TRV, DAL and RAS are current employees of Stemmatters, Biotecnologia e Medicina Regenerativa SA. Stemmatters is currently developing a proprietary medical device to be used in the context of enhanced microfracture surgical treatment. Stemmatters is actively pursuing patents related to the content of the manuscript. This manuscript was not influenced by personal or financial relationship with Stemmatters or any other third party.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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da Cunha, C.B., Andrade, R., Veloso, T.R. et al. Enhanced microfracture using acellular scaffolds improves results after treatment of symptomatic focal grade III/IV knee cartilage lesions but current clinical evidence does not allow unequivocal recommendation. Knee Surg Sports Traumatol Arthrosc 28, 3245–3257 (2020). https://doi.org/10.1007/s00167-019-05832-5

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