Clinical outcome after treatment of single and multiple cartilage defects by autologous matrix-induced chondrogenesis

Abstract

Autologous matrix-induced chondrogenesis procedure has been shown to be clinically safe and effective in isolated, larger (>2cm2) chondral defect cases. During this procedure a collagen membrane is fixed over the microfractured defect, thus promoting early mechanical stability and cartilage regeneration. Although initial indications with regards to defect size for AMIC have been set at 1.5cm2, attempts have been made to increase the possible defect area that could be covered with bioactive membrane and subsequently treated. Due to the increasing number of cases where more than one lesion and thus greater total defect areas are diagnosed, a need for understanding the modalities of treating complex cases has existed for many years. Several studies have reported on the negative impact greater size lesions have on the clinical outcome. Still, there is scarcity of data about the actual return to previous physical activity levels after some of the diagnosed defects are left untreated. Darbo tikslas ir uždaviniai Purpose: To evaluate clinical outcome of characterised treated III-IV grade and untreated I-II grade cartilage defects after autologous matrix-induced chondrogenesis. Metodika Methods: Fifteen active patients with symptomatic cartilage defects of the knee were included in the study. Defects were characterized intraoperatively according to ICRS (International cartilage repair society) by count, size, grade and the treated area. Grade III and IV lesions were treated with AMIC or AMIC in conjunction with microfracture (MF) , whereas grade I and II lesions were left untreated. All patients were divided into four subgroups: patients with one diagnosed defect (Single); 2 or 3 defects (Multiple); grade III, IV treated defect (Treated); grade III, IV treated and grade I, II untreated (Partly treated). Patients were evaluated by subjective IKDC and Tegner scores at median follow-up of 4.5 years. Rezultatai Results: Twenty-eight articular cartilage defects were diagnosed (1.9 per patient). Patients from Multiple subgroup had significantly greater diagnosed (7 ± 2.3 cm2, P = .022) and untreated (3.1 ± 2.3 cm2, P = .012) lesions areas, when compared to Single subgroup. Partly treated subgroup had a greater area of untreated defect (3.6 ± 2.3 cm2, P = .025), when compared to the Treated subgroup. […].