Abstract
Introduction
We present the first retrospective study that compares two various autologous matrix-induced chondrogenesis (AMIC) surgical interventions to repair grade III–IV cartilage defects in the knee. Patients who underwent minimally invasive (arthroscopy) or open (mini-arthrotomy) AMIC were followed up to 2 years to investigate if minimally invasive AMIC is superior to open procedures.
Materials and methods
Overall n = 50 patients with focal and contained grade III–IV articular cartilage defects in the knee joint were followed in a consecutive cohort study. 20 patients were treated arthroscopically (female 7, male 13; age: mean 38.2 years, range 18–70 years; BMI: mean 27.0, range 18.7–34.7; defect size: mean 3.1 cm2, range 1.0–6.0 cm2), and 30 patients via mini-arthrotomy (female 13, male 17; age: mean 34.4 years, range 14–53 years, BMI: mean 23.9, range 18.4–28.7; defect size: mean 3.4 cm2, range 1.5–12.0 cm2). The primary defect localization was the medial femoral condyle.
Results
AMIC led to a significant improvement of VAS pain, KOOS and Lysholm scoring for up to 2 years compared to pre-op. Outcome analysis revealed no significant differences between the two different surgical approaches.
Conclusions
Our results suggest that mini-open AMIC is equivalent to the arthroscopic procedure. The anticipatory hypothesis that minimally invasive approaches bring greater patient benefit per se could not be confirmed. Therefore, we recommend to perform AMIC where indicated and suggest that the surgeon’s personal skills profile guide the choice of surgical approach.
Level of evidence
III.
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References
Gomoll AH, Farr J, Gillogly SD, Kercher JS, Minas T (2011) Surgical management of articular cartilage defects of the knee. Instr Course Lect 60:461–483
Salzmann GM, Niemeyer P, Steinwachs M, Kreuz PC, Sudkamp NP, Mayr HO (2011) Cartilage repair approach and treatment characteristics across the knee joint: a European survey. Arch Orthop Trauma Surg 131(3):283–291
Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M, Sudkamp N (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil 14(11):1119–1125
Harris JD, Brophy RH, Siston RA, Flanigan DC (2010) Treatment of chondral defects in the athlete’s knee. Arthroscopy 6(6):841–852
Gille J, Behrens P, Volpi P, de Girolamo L, Reiss E, Zoch W, Anders S (2013) Outcome of autologous matrix induced chondrogenesis (AMIC) in cartilage knee surgery: data of the AMIC registry. Arch Orthop Trauma Surg 133(1):87–93
Benthien JP, Behrens P (2011) The treatment of chondral and osteochondral defects of the knee with autologous matrix-induced chondrogenesis (AMIC): method description and recent developments. Knee Surg Sports Traumatol Arthrosc 19(8):1316–1319
Cuellar A, Ruiz-Iban MA, Cuellar R (2016) The use of all-arthroscopic autologous matrix-induced chondrogenesis for the management of humeral and glenoid chondral defects in the shoulder. Arthrosc Tech 5(2):223–227
Fontana A (2012) A novel technique for treating cartilage defects in the hip: a fully arthroscopic approach to using autologous matrix-induced chondrogenesis. Arthrosc Tech 1(1):63–68
Piontek T, Ciemniewska-Gorzela K, Szulc A, Naczk J, Slomczykowski M (2012) All-arthroscopic AMIC procedure for repair of cartilage defects of the knee. Knee Surg Sports Traumatol Arthrosc 20(5):922–925
Sadlik B, Wiewiorski M (2015) Implantation of a collagen matrix for an AMIC repair during dry arthroscopy. Knee Surg Sports Traumatol Arthrosc 23(8):2349–2352
Usuelli FG, de Girolamo L, Grassi M, D’Ambrosi R, Montrasio UA, Boga M (2015) All-arthroscopic autologous matrix-induced chondrogenesis for the treatment of osteochondral lesions of the talus. Arthrosc Tech 4(3):255–259
Steadman JR, Miller BS, Karas SG, Schlegel TF, Briggs KK, Hawkins RJ (2003) The microfracture technique in the treatment of full-thickness chondral lesions of the knee in national football league players. J Knee Surg 16(2):83–86
Erggelet C, Sittinger M, Lahm A (2003) The arthroscopic implantation of autologous chondrocytes for the treatment of full-thickness cartilage defects of the knee joint. Arthroscopy 19(1):108–110
Kreuz PC, Muller S, Ossendorf C, Kaps C, Erggelet C (2009) Treatment of focal degenerative cartilage defects with polymer-based autologous chondrocyte grafts: four-year clinical results. Arthritis Res Ther 11(2):R33
Marcacci M, Zaffagnini S, Kon E, Visani A, Iacono F, Loreti I (2002) Arthroscopic autologous chondrocyte transplantation: technical note. Knee Surg Sports Traumatol Arthrosc 10(3):154–159
Marcacci M, Kon E, Zaffagnini S, Iacono F, Neri MP, Vascellari A, Visani A, Russo A (2005) Multiple osteochondral arthroscopic grafting (mosaicplasty) for cartilage defects of the knee: prospective study results at 2-year follow-up. Arthroscopy 21(4):462–470
Marcacci M, Marcheggiani Muccioli GM, Grassi A, Ricci M, Tsapralis K, Nanni G, Bonanzinga T, Zaffagnini S (2014) Arthroscopic meniscus allograft transplantation in male professional soccer players: a 36-month follow-up study. Am J Sports Med 42(2):382–388
Ebert JR, Fallon M, Ackland TR, Wood DJ, Janes GC (2012) Arthroscopic matrix-induced autologous chondrocyte implantation: 2-year outcomes. Arthroscopy 28(7):952–964 (e951–952)
Edwards PK, Ebert JR, Janes GC, Wood D, Fallon M, Ackland T (2014) Arthroscopic versus open matrix-induced autologous chondrocyte implantation: results and implications for rehabilitation. J Sports Rehabil 23(3):203–215
Filardo G, Kon E, Di Martino A, Iacono F, Marcacci M (2011) Arthroscopic second-generation autologous chondrocyte implantation: a prospective 7-year follow-up study. Am J Sports Med 39(10):2153–2160
Farr J, Cole BJ, Sherman S, Karas V (2012) Particulated articular cartilage: CAIS and DeNovo NT. J Knee Surg 25(1):23–29
Zantop T, Petersen W (2009) Arthroscopic implantation of a matrix to cover large chondral defect during microfracture. Arthroscopy 25(11):1354–1360
Benthien JP, Behrens P (2015) Nanofractured autologous matrix induced chondrogenesis (NAMIC©)--Further development of collagen membrane aided chondrogenesis combined with subchondral needling: a technical note. Knee 22(5):411–415
Harris JD, Siston RA, Brophy RH, Lattermann C, Carey JL, Flanigan DC (2011) Failures, re-operations, and complications after autologous chondrocyte implantation—a systematic review. Osteoarthr Cartil 19(7):779–791
Edwards PK, Ackland T, Ebert JR (2014) Clinical rehabilitation guidelines for matrix- induced autologous chondrocyte implantation on the tibiofemoral joint. J Orthop Sports Phys Ther 44(2):102–119
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The authors declare no potential conflicts of interest with respect to the research, authorship, and publication of this article.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the institutional ethical committee (98/056).
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Schagemann, J., Behrens, P., Paech, A. et al. Mid-term outcome of arthroscopic AMIC for the treatment of articular cartilage defects in the knee joint is equivalent to mini-open procedures. Arch Orthop Trauma Surg 138, 819–825 (2018). https://doi.org/10.1007/s00402-018-2887-z
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DOI: https://doi.org/10.1007/s00402-018-2887-z