Surgical management of focal chondral defects of the knee: a Bayesian network meta-analysis

Journal of Orthopaedic Surgery and Research

Nicola Maffulli¹  Alice Baroncini²  Hanno Schenker²  Jörg Eschweiler²  Filippo Migliorini²  Markus Tingart² 

[1] Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy;Centre for Sports and Exercise Medicine, Mile End Hospital, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 275 Bancroft Road, E1 4DG, London, England;School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England;Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany;

关键词: Knee;    Chondral defects;    Autologous chondrocyte implantation;    Osteochondral autograft transplantation;    Autologous matrix-induced chondrogenesis;   

DOI  :  10.1186/s13018-021-02684-z

来源: Springer

【 摘 要 】

BackgroundFocal chondral defects of the knee are common. Several surgical techniques have been proposed for the management of chondral defects: microfractures (MFX), osteochondral autograft transplantation (OAT), autologous matrix-induced chondrogenesis (AMIC) and autologous chondrocyte implantation (ACI)—first generation (pACI), second generation (cACI) and third generation (mACI). A Bayesian network meta-analysis was conducted to compare these surgical strategies for chondral defects in knee at midterm follow-up.MethodsThis Bayesian network meta-analysis was conducted according to the PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. PubMed, Google Scholar, Embase and Scopus databases were accessed in July 2021. All the prospective comparative clinical trials investigating two or more surgical interventions for chondral defects of the knee were accessed. The network meta-analyses were performed through a Bayesian hierarchical random-effects model analysis. The log odds ratio (LOR) effect measures were used for dichotomic variables, while the standardized mean difference (SMD) for the continuous variables.ResultsData from 2220 procedures (36 articles) were retrieved. The median follow-up was 36 (24 to 60) months. The ANOVA test found good baseline comparability between symptoms duration, age, sex and body mass index. AMIC resulted in higher Lysholm score (SMD 3.97) and Tegner score (SMD 2.10). AMIC demonstrated the lowest rate of failures (LOR −0.22) and the lowest rate of revisions (LOR 0.89). As expected, MFX reported the lower rate of hypertrophy (LOR −0.17) followed by AMIC (LOR 0.21). No statistically significant inconsistency was found in the comparisons.ConclusionAMIC procedure for focal chondral defects of the knee performed better overall at approximately 3 years’ follow-up.

【 授权许可】

CC BY