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Autologous chondrocyte implantation provides good long-term clinical results in the treatment of knee osteoarthritis: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the mid- and long-term efficacy of autologous chondrocyte implantation (ACI) and matrix-assisted chondrocyte implantation (MACI) to treat patients with knee cartilage defects in the presence of osteoarthritis (OA).

Methods

PubMed and Cochrane databases were systematically searched for studies describing the treatment of knee OA with ACI or MACI (Kellgren–Lawrence (KL) ≥ 1, minimum follow-up 36 months). Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and included Lysholm, Western Ontario McMaster University and International Knee Documentation Committee scores.

Results

Of the 127 full-text articles assessed for eligibility, only five studies were selected based on inclusion/exclusion criteria (2 on ACI and 3 on MACI). In both groups, the defects were mainly located at femoral level, size 2.2–15.1 cm2 in the ACI and 2.0–7.6 cm2 in the MACI group. ACI was mostly used for patients affected by KL I, whereas MACI for patients with KL II–IV. The data obtained from 235 patients (161 ACI, 74 MACI) showed that ACI and MACI sustained stable clinical improvements up to 11 and 15 years, respectively, with a failure rate of about 10% up to 11 years. Scarce biological details regarding chondrocyte implantation were reported.

Conclusions

ACI and MACI procedures for the treatment of knee cartilage lesions associated to OA showed long-term success and allowed delaying arthroplasty. Additional trials reporting homogenous data and precise patient characterization are needed to conduct an effective literature meta-analysis and identify the clinical relevance of these procedures.

Level of evidence

IV.

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Author information

Author notes

  1. F. Libonati and S. Lopa equally contributed.

Authors and Affiliations

  1. Laboratorio di Biotecnologie Applicate all’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy

    Alessandra Colombini, F. Libonati & L. de Girolamo

  2. Cell and Tissue Engineering Laboratory, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    S. Lopa & M. Moretti

  3. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy

    G. M. Peretti

  4. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    G. M. Peretti

  5. Regenerative Medicine Technologies Lab, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    M. Moretti

  6. Department of Surgery, Ente Ospedaliero Cantonale, Lugano, Switzerland

    M. Moretti

  7. Faculty of Biomedical Sciences, Euler Institute, USI, Lugano, Switzerland

    M. Moretti

Authors
  1. Alessandra Colombini
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  2. F. Libonati
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  3. S. Lopa
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  4. G. M. Peretti
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  6. L. de Girolamo
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Contributions

Conceptualization: AC; LdG; data collection: AC; FL; SL; analysis and interpretation of results: AC; FL; SL; writing—original draft preparation: AC; writing—review and editing: FL; SL; PGM; MM; LdG; supervision: PGM; MM; LdG.

Corresponding author

Correspondence to Alessandra Colombini.

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The authors declare no conflict of interest.

Funding

The work reported in this publication was funded by the Italian Ministry of Health, RCR-2021-23671217 project, under the The Italian Musculoskeletal Apparatus Network RAMS.

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Colombini, A., Libonati, F., Lopa, S. et al. Autologous chondrocyte implantation provides good long-term clinical results in the treatment of knee osteoarthritis: a systematic review. Knee Surg Sports Traumatol Arthrosc 31, 2338–2348 (2023). https://doi.org/10.1007/s00167-022-07030-2

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