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Accelerated weight-bearing after MACI of knee defects seen as safe
BOSTON — High levels of patient satisfaction and tissue durability beyond 10 years were seen with matrix-induced autologous chondrocyte implantation for the treatment of symptomatic knee chondral defects, according to a presenter at the American Orthopaedic Society for Sports Medicine Annual Meeting. The randomized trial showed accelerated weight-bearing rehabilitation was safe and effective and improved early patient outcomes.
Researchers performed a randomized controlled trial of 70 patients who underwent matrix-induced autologous chondrocyte implantation (MACI) for the treatment of symptomatic knee chondral defects and underwent either an accelerated or conservative approach to postoperative weight-bearing rehabilitation. Patients were evaluated preoperatively and at 3, 6, 12 and 24 months and at 5 years postoperatively. There were 60 patients available for follow-up at 10 years postoperatively. Clinical outcomes assessed included the IKDC, KOOS, Lysholm, Tegner, SF-36 and satisfaction scores and maximal isokinetic knee extensor and flexor strength and functional hop capacity. MRIs were used to evaluate the quality and quantity of tissue repair as per the MR observation of cartilage repair tissue (MOCART) scoring system.
Results showed significantly less knee pain earlier in the postoperative timeline for patients who underwent accelerated weight-bearing. At the 10-year minimum follow-up, no significant differences were seen between weight-bearing groups with regard to patient demographics, injury/surgery characteristics, clinical or MRI scores. At 5 years, all clinical scores improved in both groups and were maintained at 10 years postoperatively. No differences were seen in mean limb symmetry indices scores for maximal isokinetic knee extension strength and single- and triple-hop tests for distance at 10 years postoperatively.
There were 82.4% of patients who underwent accelerated weight-bearing and 83.3% of patients who underwent conservative weight-bearing who showed a good to excellent MRI composite score at 10 years postoperatively. Additionally, 79.4% of accelerated weight-bearing patients and 83.3% of conservative weight-bearing patients showed good to excellent tissue infill based on the MOCART score.
At 10 years postoperatively, graft failure was seen on MRI in five patients. There were 93.3% of patients satisfied with MACI for pain relief, while 83.4% were satisfied with their ability to participate in sports. – by Monica Jaramillo
Reference:
Ebert JR, et al. Abstract 14. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 11-14, 2019; Boston.
Disclosure: Ebert reports no relevant financial disclosures.