Autologous Matrix-Induced Chondrogenesis (AMIC) and AMIC Enhanced by Autologous Concentrated Bone Marrow Aspirate (BMAC) Allow for Stable Clinical and Functional Improvements at up to 9 Years Follow-Up: Results from a Randomized Controlled Study.

Laura De Girolamo,Gabriele Thiebat,Piero Volpi,Herbert Schönhuber,Marco Viganò,Alessandro Quaglia,Corrado Bait

doi:10.3390/jcm8030392

Abstract

The aims of the study were to evaluate long-term outcomes after autologous matrix-induced chondrogenesis (AMIC) in the treatment of focal chondral lesions and to assess the possible improvements given by the combination of this technique with bone marrow aspirate concentrate (BMAC). Twenty-four patients (age range 18–55 years) affected by focal knee chondral lesions were treated with standard AMIC or AMIC enhanced by BMAC (AMIC+). Pain (Visual Analogue Scale (VAS)) and functional scores (Lysholm, International Knee Documentation Committee (IKDC), Tegner, Knee injury and Osteoarthritis Outcome Score (KOOS)) were collected pre-operatively and then at 6, 12, 24, 60, and 100 months after treatment. Magnetic resonance imaging (MRI) evaluation was performed pre-operatively and at 6, 12, and 24 months follow-ups. Patients treated with AMIC+ showed higher Lysholm scores (p = 0.015) and lower VAS (p = 0.011) in comparison with patients in the standard AMIC group at the 12 months follow-up. Both treatments allowed for functional and pain improvements with respect to pre-operative levels lasting up to 100 months. MRI revealed consistent cartilage repair at 24 months in both groups. This study shows that AMIC and AMIC+ are effective treatments for focal chondral lesions with beneficial effect lasting up to 9 years. AMIC+ allows for faster recovery from injury, and is thus more indicated for patients requiring a prompt return to activity. Level of evidence: II, randomized controlled trial in an explorative cohort.

Highlights

Articular cartilage injuries represent an issue in current orthopedics surgery, due to the high prevalence in the active population and to the low healing potential of hyaline cartilage [1]
The aims of the study were to evaluate long-term outcomes after autologous matrix-induced chondrogenesis (AMIC) in the treatment of focal chondral lesions and to assess the possible improvements given by the combination of this technique with bone marrow aspirate concentrate (BMAC)
Twenty-four patients affected by focal knee chondral lesions were treated with standard AMIC or AMIC enhanced by BMAC (AMIC+)

Summary

Introduction

Articular cartilage injuries represent an issue in current orthopedics surgery, due to the high prevalence in the active population and to the low healing potential of hyaline cartilage [1]. Some approaches, such as autologous chondrocyte implantation (ACI), require two subsequent surgeries for cell harvesting and transplantation with higher costs and risks related to the procedure. Others, such as microfractures of the subchondral bone, may result in unsatisfactory tissue healing, with the production of fibrocartilaginous tissue, and poor long-term clinical results [7,8,9,10]. Satisfactory results using this approach have been already reported at medium- and long-term follow-ups, with pain reduction and functional improvement up to 7 years [14,15,16,17]

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Discussion

Conclusion