Matrix-Applied Characterized
Autologous Cultured Chondrocytes Versus Microfracture: Two-Year Follow-up of a
Prospective Randomized Trial

D, Price A, Widuchowski W, Bertrand-Marchand M, Caron J, Drogset JO, Emans P,
Podskubka A, Tsuchida A, Kili S, Levine D, & Brittberg M. Am J Sports Med.  2014 Published Online First April 8, 2014:
doi: 10.1177/0363546514528093

Take Home Message: At 2 years
post-surgery, matrix-applied characterized autologous cultured chondrocytes had
superior clinical outcomes compared with microfracture surgery for management
of large cartilage lesions.  Structurally
there were no differences between this technique and microfracture at the same
2 year follow-up point.

cartilage lesions can happen in isolation or concomitant to injury and represent
a major treatment challenge to long-term knee health.  Microfracture and matrix-applied
characterized autologous cultured chondrocytes (MACI) are two common surgical
approaches utilized to achieve good clinical outcomes (e.g., pain, function)
following a knee cartilage lesion.  This
randomized study compared clinical outcomes at baseline and at a 2 year-follow
up among 144 participants with large cartilage knee lesions (> 3cm2)
who received either the MACI or microfracture techniques.  Despite both groups improving over time, participants
who underwent MACI had better improvements at the 2 year follow-up with all 5 KOOS
subscores, which are self-reported knee outcome measures, than those that
underwent microfracture.  MACI participants
also included a higher percentage of responders than microfracture.  MACI participants also had better
improvements in the physical component of the short form health survey than microfracture
participants, but both groups had increases in quality of life and overall
health status over the 2 year follow up period. 
A subset of the study population (116 participants) underwent a second
arthroscopic biopsy/observation surgery and no differences were found between techniques
with tissue assessment (macro- or microscopically).

MACI and microfracture participants improved from baseline over the 2 year
follow up; however, MACI participants had better self-reported knee clinical
outcomes than microfracture patients. 
This study focused on patients with large cartilage lesions where MFX is
sometimes not as successful.  It may be
interesting to see if the same comparison was done in lesions smaller than 3 cm2
to see if the results would be similar as well. 
It is interesting that upon visual inspection and biopsy there was no
differences detected between the groups. 
So it remains unclear as to why clinical differences may be seen.  Furthermore, 2 years is early to determine
any metabolic tissue or structural changes. 
Following these patients to longer follow-up periods would be of
tremendous value to see if there are any ensuing structural changes.  It may be that the clinical measures are
precursors to impending structural changes. 
In the meantime, this study supports the use of MACI over microfracture
when treating larger cartilage lesions.

Questions for Discussion:  Do
you have any patients that have undergone either of these 2 surgical
techniques?  What surgical technique are
you seeing used more commonly in your patient population? 
by: Nicole Cattano
by: Jeffrey Driban

Related Posts:

Saris, D., Price, A., Widuchowski, W., Bertrand-Marchand, M., Caron, J., Drogset, J., Emans, P., Podskubka, A., Tsuchida, A., Kili, S., Levine, D., Brittberg, M., , ., Pa a, L., Trc, T., Slynarski, K., Sanson, B., & Bezuidenhoudt, M. (2014). Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture: Two-Year Follow-up of a Prospective Randomized Trial The American Journal of Sports Medicine DOI: 10.1177/0363546514528093