Is implantation of autologous chondrocytes superior to microfracture for articular-cartilage defects of the knee? A systematic review of 5-year follow-up data

INTERNATIONAL JOURNAL OF SURGERY

卷:68

Review

Na, Yuyan¹  Shi, Yuting²  Liu, Wanlin³  Jia, Yanbo¹  Kong, Lingyue¹  Zhang, Ting¹  Han, Changxu¹  Ren, Yizhong¹ 

[1] Inner Mongolia Med Univ, Affiliated Hosp 2, Dept Arthroscopy & Sports Med, Hohhot 010000, Inner Mongolia, Peoples R China

[2] Inner Mongolia Autonomous Reg Peoples Hosp, Cadre Hlth Care Ctr, Cardiac Funct Dept, Hohhot 010000, Inner Mongolia, Peoples R China

[3] Inner Mongolia Med Univ, Affiliated Hosp 2, Dept Pediat Orthoped, Hohhot 010000, Inner Mongolia, Peoples R China

关键词: Articular cartilage;    Knee;    Autologous chondrocyte implantation (ACI);    Microfracture;    Systematic review;   

DOI  :  10.1016/j.ijsu.2019.06.007

来源: Elsevier

【 摘 要 】

Background: Autologous chondrocyte implantation (ACI) and microfracture are two of the main surgical treatment options for articular cartilage lesions of the knee. Consensus regarding the best clinical options to repair knee cartilage lesions is lacking. We undertook a systematic review to clarify the clinical efficacy of ACI and microfracture at minimum mean 5-year follow-up. Methods: A literature search was conducted using the MEDLINE, Embase and Cochrane Library databases up to August 2018. Only comparative clinical studies of ACI and microfracture for the treatment of articular cartilage lesions of the knee with level I/II evidence were included. Clinical outcomes and the prevalence of treatment failure from each study were extracted and compared. The methodological quality of the included studies was analyzed by means of the PEDro scale. Results: Five comparative studies (three randomized controlled trials and two prospective cohort studies) met our eligibility criteria. ACI and microfracture elicited significant improvement in clinical outcomes after 5 years. However, better clinical results with significant differences were found with modified versions of ACI (ACI with a modified collagen membrane [ACI-C] or matrix-applied chondrocyte implantation [MACI]) than with microfracture as determined by the Knee Injury and Osteoarthritis Outcome Score, activities of daily living assessment, Tegner Activity Scale score, and the International Knee Documentation Committee objective and subjective scores. No significant difference was observed in the treatment failure rate between these two methods within a particular study. Conclusions: Currently, the best-available evidence suggests that some clinical outcomes of articular cartilage lesions of the knee treated with modified versions of ACI (ACI-C or MACI) can significantly improve patient outcomes at the mid-term follow-up of 5 years compared with those obtained using microfracture.

【 授权许可】

Free