Abstract
Different surgical procedures have been proposed over the past few years to treat cartilage lesions. The aim of this study was to compare mosaicplasty and matrix-assisted autologous chondrocyte transplantation (MACT) at long-term follow-up. Forty-three patients were included: 20 mosaicplasty and 23 MACT. Patients were evaluated before and 12 years after surgery with the International Knee Documentation Committee (IKDC) subjective and objective scores for symptoms and function, and with the Tegner score for activity level. Magnetic Resonance Imaging (MRI) was used to evaluate repair tissue with the MOCART 2.0 score. Mosaicplasty and MACT showed good clinical and MRI results (IKDC subjective score 75.3 ± 21.8 and 81.8 ± 13.0, both p < 0.0005). Mosaicplasty presented a 10% reoperation rate and a 25% overall failure rate, while no failures were documented in MACT (p = 0.016). While size did not influence the results in the MACT group, mosaicplasty presented lower IKDC objective and Tegner scores in lesions bigger than 2 cm2 (p = 0.031 and p = 0.014, respectively). Mosaicplasty and MACT presented both satisfactory clinical and MRI results at long-term follow-up. However, for larger lesions, MACT presented better subjective and objective outcomes, as well as less failures, which should be considered when choosing the most suitable treatment for patients affected by knee cartilage lesions.
Highlights
Articular cartilage lesions of the knee are a common issue, often affecting a young population and causing pain and functional impairment, with consequent high social impact [1,2]
In the matrix-assisted autologous chondrocyte transplantation (MACT) group there was a significant improvement from the basal level of 37.6 ± 14.9 to the final follow-up of 81.8 ± 13.0
The main finding of this study is that both mosaicplasty and MACT techniques provided satisfactory clinical results at long-term follow-up in two homogeneous groups of patients affected by knee cartilage defects
Summary
Articular cartilage lesions of the knee are a common issue, often affecting a young population and causing pain and functional impairment, with consequent high social impact [1,2]. Due to the limited cartilage healing potential and the difficulty to restore complex biomechanical features, chondral defects remain a challenging problem [3]. To avoid their deleterious consequences, such as the risk of further cartilage loss and osteoarthritis (OA) development, numerous surgical procedures have been proposed over the years to restore the articular surface with hyaline-like, durable repair tissue, Appl. Sci. 2020, 10, 4615 from reconstructive techniques to the more ambitious regenerative strategies [4,5,6,7] For these surgical approaches, the first procedures described were osteochondral autologous transplantation (OAT)
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