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      Outcome of Autologous Matrix Induced Chondrogenesis (AMIC) in cartilage knee surgery: data of the AMIC Registry

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          Abstract

          Introduction

          Autologous Matrix-Induced Chondrogenesis (AMIC) is an innovative treatment for localized full-thickness cartilage defects combining the well-known microfracturing with collagen I/III scaffold. The purpose of this analysis was to evaluate the medium-term results of this enhanced microfracture technique for the treatment of chondral lesions of the knee.

          Methods and materials

          Patients treated with AMIC (Chondro-Gide ®, Geistlich Pharma, Switzerland) were followed using the AMIC Registry, an internet-based tool to longitudinally track changes in function and symptoms by the Lysholm score and VAS.

          Results

          A series of 57 patients was enrolled. The average age of patients (19 females, 38 males) was 37.3 years (range 17–61 years). The mean defect size of the chondral lesions was 3.4 cm 2 (range 1.0–12.0 cm 2). All defects were classified as grade III ( n = 20) or IV ( n = 37) according to the Outerbridge classification. Defects were localized at the medial ( n = 32) or lateral ( n = 6) condyle, at the trochlea ( n = 4) and at the patella ( n = 15). The follow-up period was 2 years. The majority of patients were satisfied with the postoperative outcome, reporting a significant decrease of pain (mean VAS preop = 7.0; 1 year postop = 2.7; 2 years postop = 2.0). Significant improvement of the mean Lysholm score was observed as early as 1 year after AMIC and further increased values were noted up to 2 years postoperatively (preop. 50.1, 1 year postop. 79.9, 2 year postop. 85.2).

          Conclusions

          AMIC is an effective and safe method of treating symptomatic chondral defects of the knee. However, further studies with long-term follow-up are needed to determine if the grafted area will maintain structural and functional integrity over time.

          Level of evidence

          Prognostic study, Level IV.

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          Most cited references28

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          The etiology of chondromalacia patellae.

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            A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years.

            The optimal treatment for cartilage lesions has not yet been established. The objective of this randomized trial was to compare autologous chondrocyte implantation with microfracture. This paper represents an update, with presentation of the clinical results at five years. Eighty patients who had a single chronic symptomatic cartilage defect on the femoral condyle in a stable knee without general osteoarthritis were included in the study. Forty patients were treated with autologous chondrocyte implantation, and forty were treated with microfracture. We used the International Cartilage Repair Society, Lysholm, Short Form-36, and Tegner forms to collect clinical data, and radiographs were evaluated with use of the Kellgren and Lawrence grading system. At two and five years, both groups had significant clinical improvement compared with the preoperative status. At the five-year follow-up interval, there were nine failures (23%) in both groups compared with two failures of the autologous chondrocyte implantation and one failure of the microfracture treatment at two years. Younger patients did better in both groups. We did not find a correlation between histological quality and clinical outcome. However, none of the patients with the best-quality cartilage (predominantly hyaline) at the two-year mark had a later failure. One-third of the patients in both groups had radiographic evidence of early osteoarthritis at five years. Both methods provided satisfactory results in 77% of the patients at five years. There was no significant difference in the clinical and radiographic results between the two treatment groups and no correlation between the histological findings and the clinical outcome. One-third of the patients had early radiographic signs of osteoarthritis five years after the surgery. Further long-term follow-up is needed to determine if one method is better than the other and to study the progression of osteoarthritis.
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              Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study.

              Autologous chondrocyte implantation (ACI) is used widely as a treatment for symptomatic chondral and osteochondral defects of the knee. Variations of the original periosteum-cover technique include the use of porcine-derived type I/type III collagen as a cover (ACI-C) and matrix-induced autologous chondrocyte implantation (MACI) using a collagen bilayer seeded with chondrocytes. We have performed a prospective, randomised comparison of ACI-C and MACI for the treatment of symptomatic chondral defects of the knee in 91 patients, of whom 44 received ACI-C and 47 MACI grafts. Both treatments resulted in improvement of the clinical score after one year. The mean modified Cincinnati knee score increased by 17.6 in the ACI-C group and 19.6 in the MACI group (p = 0.32). Arthroscopic assessments performed after one year showed a good to excellent International Cartilage Repair Society score in 79.2% of ACI-C and 66.6% of MACI grafts. Hyaline-like cartilage or hyaline-like cartilage with fibrocartilage was found in the biopsies of 43.9% of the ACI-C and 36.4% of the MACI grafts after one year. The rate of hypertrophy of the graft was 9% (4 of 44) in the ACI-C group and 6% (3 of 47) in the MACI group. The frequency of re-operation was 9% in each group. We conclude that the clinical, arthroscopic and histological outcomes are comparable for both ACI-C and MACI. While MACI is technically attractive, further long-term studies are required before the technique is widely adopted.
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                Author and article information

                Contributors
                +49-451-5002642 , justus_gille@usa.net
                Journal
                Arch Orthop Trauma Surg
                Arch Orthop Trauma Surg
                Archives of Orthopaedic and Trauma Surgery
                Springer-Verlag (Berlin/Heidelberg )
                0936-8051
                1434-3916
                16 October 2012
                16 October 2012
                January 2013
                : 133
                : 1
                : 87-93
                Affiliations
                [ ]Department of Trauma and Reconstructive Surgery, University Of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
                [ ]CUNO Hamburg, Hamburg, Germany
                [ ]Istituto Clinico Humanitas, Milan, Italy
                [ ]IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
                [ ]OrthoPraxis Oftringen, Oftringen, Switzerland
                [ ]Heidekreis Klinikum, Soltau, Germany
                [ ]Rheuma- und Orthopädiezentrum, Bad Abbach, Germany
                [ ]Department of Trauma and Orthopaedics, University of Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
                Article
                1621
                10.1007/s00402-012-1621-5
                3535369
                23070222
                06cb8170-8805-4980-9ed6-d1c1809a516e
                © The Author(s) 2012
                History
                : 27 February 2012
                Categories
                Arthroscopy and Sports Medicine
                Custom metadata
                © Springer-Verlag Berlin Heidelberg 2013

                Orthopedics
                amic,cartilage,knee,surgery,lysholm score
                Orthopedics
                amic, cartilage, knee, surgery, lysholm score

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