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Results equivalent for patients undergoing microfracture and autologous chondrocyte implantation
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CHICAGO — Patients who underwent microfracture for treatment of a full-thickness cartilage defect in the knee experienced equal clinical and radiological long-term outcomes compared with those who underwent autologous chondrocyte implantation, according to a presenter here.
“We can conclude that both [microfracture and autologous chondrocyte implantation (ACI)] show significant improvement in functional long-term outcomes and a moderate radiological outcome,” Benjamin Erdle, MD, said at the International Cartilage Repair Society Annual Meeting. “At least with this group of patients, the first generation of ACI with a periostal flap seems to be inferior to microfracturing concerning the functional long-term outcome and, in this case, independent of lesion size.”
Erdle and colleagues matched 22 patients who underwent microfracture and 22 patients who underwent ACI 10 years prior for full-thickness cartilage lesions grade III and IV according to patient age, sex, BMI, time to follow-up and localization of the lesion. VAS for pain, Lysholm and Tegner score, as well as qualitative and quantitative MRI analysis, were evaluated.
Study results showed both microfracture and ACI led to a significant reduction in pain, as well as significant improvement in functional outcomes. However, the microfracture group had a significantly better Tenger outcome vs. ACI, according to Erdle.
“Turning to Tegner activity score we found, consistent with the indication for ACI in more active patients, a preoperative significant difference between the two groups. This led to a small decrease in the ACI group at follow-up and the significant increase in the microfracture group,” Erdle said.
Based on patients’ magnetic resonance observation of cartilage repair tissue scores, the microfracture group experienced a slightly better integration, a more homogenous regenerative structure and a more Isointense signal intensity, according to the researchers. Erdle added the microfracture group also had a significantly higher T2 relaxation time of the healthy femur control cartilage, as well as a tendency for higher T2 relaxation time in the interface region vs. ACI.
“To cut out the lesion size difference, we performed a subgroup analysis comparing the larger lesions that had undergone microfracturing with the smaller lesions that had undergone ACI,” Erdle said. “Here, we also found no difference compared to the whole group, showing a significantly stronger Lysholm score in the microfracturing group compared to the ACI group.”
Erdle said no differences were observed between the sub group and the whole group for radiological outcomes. – by Casey Tingle
Reference:
Erdle B, et al. Long-term matched-pair analysis after microfracture versus first-generation autologous chondrocyte implantation in the knee. Presented at: International Cartilage Repair Society Annual Meeting. May 8-11, 2015; Chicago.
Disclosure: Erdle reports no relevant financial disclosures.