Arthroscopic Autologous Matrix-induced Chondrogenesis Research Articles

Significant Clinical Improvement After Arthroscopic Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 5-Year Follow-Up.

This study aims to evaluate the clinical outcomes of arthroscopic autologous matrix-induced chondrogenesis (A-AMIC) for osteochondral lesions of the talus (OLT) at 24 months and 60 months of follow-up. The secondary aim was to assess whether age, body mass index (BMI), and lesion surface affect outcomes. Sixty-three patients (32 males, 31 females) with a median age of 37 years [interquartile range (IQR): 25-48] were included. Preoperative and postoperative (24 months and 60 months) clinical outcomes were evaluated using a Visual Analog Score (VAS) for pain during walking, the American Orthopaedic Foot and Ankle Society (AOFAS), Short-Form Survey (SF-12), the Halasi, and the University of California, Los Angeles (UCLA) scores. Patients were categorized according to age, BMI, and lesion surface (1-1.5 cm2 and over 1.5 cm2). The effect of each category was evaluated. There were significant improvements in the VAS, AOFAS, SF-12, and UCLA, comparing the preoperative scores to the 60-month follow-up scores (P < 0.001). There were no significant differences in the above-mentioned outcomes between the follow-up periods. Patients older than 33 years had lower SF-12, Halasi, and UCLA scores (P = 0.005, 0.004, and <0.001, respectively). Overweight patients had lower VAS, SF-12, Halasi, and UCLA scores (P = 0.006, 0.002, 0.024, and 0.007, respectively). Lesion size was uninfluential. A-AMIC yielded clinical improvements at a minimum follow-up of 60 months in patients with symptomatic OLTs, with clinical improvement peaking in the first 2 years, followed by a plateau period. Increased age and BMI were significantly associated with inferior outcomes.

Mid-term results of autologous matrix-induced chondrogenesis surgery with or without scaffolds for arthroscopic treatment of deep talus osteochondral lesions: A comparative study.

This study aims to investigate the effectiveness of arthroscopic autologous matrix-induced chondrogenesis (AMIC) procedure with or without polyglycolic acid-hyaluronic acid (PGA-HA)-based cell-free scaffold (CFS) in Bristol Stage 4 and Stage 5 osteochondral lesion of the talus (OLT) ranging between 1.5 and 3 cm2 . Between March 2018 and March 2021, a total of 47 patients with OLTs (29 males, 18 females; mean age: 22.8±2.3 years; range, 18 to 65 years) were retrospectively analyzed. The patients were divided into two groups based on the procedures applied. Patients in the first group (Group 1, n=23) underwent the AMIC procedure alone (curettage, microfracture, and grafting), while patients in the second group (Group 2, n=24) underwent AMIC procedure with PGA-HA-based CFS. The localization of the lesions was evaluated. All OLTs were diagnosed with preoperative radiography and magnetic resonance imaging (MRI). During the preoperative period, lesion stages were evaluated based on the Bristol staging system, and the postoperative results were evaluated based on the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. The mean follow-up was 36.2±5.6 months. In the early period, the three-month functional scores were comparable between the groups. While a significant increase was observed in the American Orthopaedic Foot and Ankle Society (AOFAS) scores from the mean preoperative of 62.71±4.44 points to the postoperative of 86.00±6.58 points in Group 1, a significant increase in the AOFAS score was observed from 65.28±7.91 points to 95.42±4.41 points in Group 2 at 12-month follow-up (p=0.016, p=0.011, respectively). The functional scores tended to progress after 12 months. Radiologically, a complete defect filling was observed in a mean of 10.5±2.7 months. No graft hypertrophy was recorded in any patients. The AOFAS and MOCART scores in Group 2 were found to be statistically significantly higher than that in Group 1 (p=0.034 for AOFAS 1/AOFAS 2 and p=0.006 for MOCART 1/MOCART 2). Overall, there was a positive, but weak, significant correlation between the final AOFAS scores and MOCART scores (r=0.347, p<0.001). Arthroscopic AMIC procedure in deep OLTs between 1.5 cm2 and 3 cm2 can yield a statistically significant improvement both clinically and radiologically; however, the use of a PGA-HA-based CFS in addition to this procedure can improve the clinical and radiological recovery.

Osteochondral lesions of the talar dome in the athlete: what evidence leads to which treatment

Osteochondral lesions of the talar dome in the athlete: what evidence leads to which treatment

Sustained benefit of autologous matrix-induced chondrogenesis for hip cartilage repair in a recreational athletic population.

To investigate the clinical outcome of autologous matrix-induced chondrogenesis (AMIC) implementation for mid-sized chondral lesions of the acetabulum in young active patients, and assess their potential to resume an active lifestyle including return to recreational athletic activities. Sixty-two patients with full-thickness mid-sized acetabular chondral lesions were studied. All patients who underwent an arthroscopic AMIC procedure for reconstruction of chondral defects were assessed pre-operatively and at least 2years post-operatively using the Hip disability and Osteoarthritis Outcome Score (HOOS), modified Harris Hip Score (mHHS) and Visual Analog Scale (VAS) for pain. A significant improvement in all three scores at the time of follow-up was found. The mean HOOS improved from 58.8 ± 7.4 pre-operatively to 90.6 ± 7.1 at follow-up (p < 0.001) while the mean mHHS improved from 53.4 ± 6.6 to 82.4 ± 8.2 (p < 0.001). There was a significant decrease from 4.9 ± 1.1 pre-operatively to 1.1 ± 0.8 post-operatively (p < 0.001) in the VAS pain evaluation, indicating that the patients were satisfied with their relief of pain. The AMIC procedure is an effective single-stage technique for the reconstruction of mid-size chondral defects of acetabulum in amateur athletes. This intervention enhanced the potential for patients to resume recreational athletic activities and the 2-year clinical outcome as evaluated by the HOOS, mHHS and VAS showed significant improvement over the pre-operative evaluations.

Return to Sport After Arthroscopic Autologous Matrix-Induced Chondrogenesis for Patients With Osteochondral Lesion of the Talus.

To determine the rate of return of patients to sport after arthroscopic autologous matrix-induced chondrogenesis (AT-AMIC) for outcomes 2 years after surgery. Retrospective observational cross-sectional study. C.A.S.C.O.-Foot and Ankle Unit, Istituto Ortopedico Galeazzi, Milan, Italy. Twenty-six consecutive patients, 65.4% male (mean ± SD age: 33.7 ± 11.0 years), that underwent AT-AMIC procedure between 2012 and 2015 were selected retrospectively. From this population, only sporting patients at amateur's level were included. Arthroscopic autologous matrix-induced chondrogenesis was proposed in patients with pain and persistent disability. All patients were assessed with the American Orthopaedic Foot and Ankle Score (AOFAS), physical component score of the 12-Item Short Form Health Survey (SF-12), Halasi ankle activity score, and University of California, Los Angeles (UCLA) activity scale preoperatively and at 24 months postoperatively. Overall, 80.8% of the patient group returned to the same preinjury sport. The mean follow-up was 42.6 ± 10.9 months (range from 25 to 62 months). Significant differences were observed with reference to AOFAS, SF-12, Halasi, and UCLA scores at the last follow-up in patients who had undergone AT-AMIC (all, P < 0.001). A high percentage of patients return to their preinjury sport after AT-AMIC surgery.

A critical review of the literature on arthroscopic autologous matrix-induced chondrogenesis and matrix-assisted autologous chondrocyte transplantation for acetabular chondral defects

Background/Aims Significant acetabular chondral defects are a common clinical finding during hip arthroscopy, for which the current surgical management approach may be falling short. Autologous matrix-induced chondrogenesis and matrix-assisted autologous chondrocyte transplantation are two novel cell-regenerative therapies that offer a way to repair acetabular chondral defects. Methods A literature search of Cochrane, CINAHL, AMED and Medline (2007–2017) databases revealed seven relevant articles, but only four involved a hip arthroscopic approach. Results All included studies demonstrated some significant improvements in patient-reported outcomes for autologous matrix-induced chondrogenesis and matrix-assisted autologous chondrocyte transplantation. There appears to be a practical advantage in terms of cost and convenience for using one-step autologous matrix-induced chondrogenesis. However, over-reliance on one particular research team and use of small-scale retrospective studies constitutes low-level, non-generalisable evidence. Conclusions The literature does not convincingly support either of these new applications over and above any other currently available treatments. Further research is needed and should involve different centres, longer follow-ups and place a higher emphasis on methodological rigour in order to maximise the trustworthiness of results.

Sports and physical activity after osteochondral talar reconstruction with arthroscopic autologous matrix-induced chondrogenesis

Category: Sports Introduction/Purpose: Osteochondral talar lesions (OLTs) are common entities in active patients who practice sports. Degenerative changes and development of osteoarthritis can occur in up to 50% of non-treated patients, due to poor chondral tissue healing abilities. In recent years, autologous matrix-induced chondrogenesis (AMIC) repair has been introduced for OLTs with satisfactory results through medium-term follow-up. The aim of the study was to evaluate the return to sport and physical activities in patients underwent arthroscopic autologous matrix-induced chondrogenesis (AT-AMIC) 2 years after surgery. Methods: This is an observational cross-sectional study. Informed consent was obtained from all participants, and procedures were conducted according to the Declaration of Helsinki. Twenty-seven consecutive patients, 62.9% (17) male (mean ± SD age: 33.7±11.2 years), that underwent AT-AMIC were included in the study. All patients were assessed with the American Orthopaedic Foot &amp; Ankle Score (AOFAS), physical component score of the 12-Item Short Form Health Survey (PCS-SF-12), HALASI ankle activity score and University of California, Los Angeles (UCLA) activity scale preoperatively and at 24 months after surgery. Results: Overall, 81.48% of the patient group returned to the same preinjury sport. Mean follow-up was 42.7 ±11.1 months. A significant interaction with time (from pre-operative to the final follow-up) for the clinical parameters UCLA, Halasi, AOFAS and SF-12 was found, P&lt;0.001). In addition, there were significant differences between preoperative versus last follow-up (all, P &lt;0.001), Conclusion: A high percentage of patients return to their sport activity after osteochondral talar reconstruction with AT-AMIC technique; furthermore AT-AMIC improve quality of life in young and active patients, allowing return to sport.

4-5 Year Results Following AMIC Procedure with Collagen Matrix in Cartilage Reconstruction of the Talus

Category: Ankle, Arthroscopy Introduction/Purpose: In recent years, the autologous matrix-induced chondrogenesis (AMIC) has established itself in the treatment of cartilage defects of the talus. In this prospective study, the 4-5 year results following arthroscopic AMIC technique at the Talus will be presented. Methods: 97 patients has been treated with this method from August 2009 until September. 48 patients (26 F, 22 M) with a mean age of 36.5 ± 3.9 years (15-69) and a BMI of 24.8 ± 3.9 (19.1 to 39.6) met the inclusion criteria. The Hannover scoring system (HSS) and VAS score for pain, function and satisfaction at baseline and 1 year (FU1), 2 years (FU2) and 4.4 years (FU3) postoperatively have been evaluated. Following arthroscopic exploration to control the inclusion criteria, the cartilage defect was debrided thoroughly. Subsequently, microfracturing has been performed with a special swan neck awls and then PRP was injected over the subchondral plate. Afterwards, covering of the defect area was carried out with the collagen matrix (AMIC) which was impregnated with PRP, which was then fixed with fibrin glue. Results: The HSS improved from 55.6 ± 12.18 baseline to 82.3 FU1 ± 15.64 (p &lt;0.05 compared to baseline.), FU2 88.8 ± 7,43 (p &lt;0,05 see to baseline) and FU3 89.7 ± 8.3 (p &lt;0.05 compared to baseline) with a significant improvement over the entire period of p = 0.008. VAS for pain was 4 ± 2.74 at the Baseline and improved at FU1 to 7.8 ± 2.73 (p &lt;0.05, compared to baseline.), FU2 8.9 ± 1.01 (p &lt;0.05) and FU3 9.3 ± 1.26 (p &lt;0.05) with a significant improvement over the entire period of p = 0.001. Similar results were observed in the VAS scores for function and satisfaction. There were no infections or surgical complications. Conclusion: The arthroscopic AMIC procedure also shows good mid-term results in treatment of cartilage defects of the talus. It is a promising and safe procedure in the cartilage therapy with a low complication rate through an arthroscopic surgery.

Long-Term Benefit of Arthroscopic Autologous Matrix-Induced Chondrogenesis Compared to Microfracture for Femoral Acetabular Impingement-Induced Chondral Lesions

Long-Term Benefit of Arthroscopic Autologous Matrix-Induced Chondrogenesis Compared to Microfracture for Femoral Acetabular Impingement-Induced Chondral Lesions

The Use of All-Arthroscopic Autologous Matrix-Induced Chondrogenesis for the Management of Humeral and Glenoid Chondral Defects in the Shoulder

Autologous matrix-induced chondrogenesis (AMIC) is often used for treating chondral defects in different joints. We describe an all-arthroscopic approach for the treatment of glenoid and humeral chondral lesions with this technique. AMIC starts with the use of microfractures of the damaged cartilage, followed by coverage of the defect with a type I/III collagen matrix (Chondro-Gide; Geistlich Pharma, Wolhusen, Switzerland) that is fixed with fibrin glue (Tissucol; Baxter, Warsaw, Poland). In a 1-step approach, the unstable cartilage is debrided, microfractures that penetrate up to the subchondral bone are performed, and the membranes are pasted to the lesion. Our technique reduces morbidity rates compared with traditional open surgery. The arthroscopic AMIC procedure is a viable, cost-effective treatment for the repair of chondral lesions of the shoulder.

Premiers résultats confirment l’efficacité et la sécurité des arthroscopiques de chondrogenèse autologue induite par matrice méthode la régénération du cartilage genou

Objective To evaluate change over time of clinical scores and morphological MRI of cartilage appearance after full arthroscopic autologous matrix-induced chondrogenesis (AMIC) of the knee. Methods From a database of AMIC patients, all consecutive patients’ (age 13–63) treatment of knee cartilage lesions by autologous matrix-induced chondrogenesis (AMIC) from April 2010 to December 2011 were identified. All patients had been assessed preoperatively, and 6, 12 and 24 months postoperatively. Following information have been recorded: IKDC 2000 subjective score, IKDC 2000 clinical evaluation score and Lysholm score. All patients in the study had been assessed with MRI (morphological sequences) 6, 12 and 24 months postoperatively. Results Twenty-eight patients were identified for analysis with a median follow-up of 2 years (2,0–2,6). There were 23 patients treated with concomitant knee procedures such as ACL or PCL reconstruction, meniscal treatment and medial patelo-femoral ligament reconstruction. We had observed statistically significant improvement for Lysholm scale from 70,9 preoperatively to 86,5, 86,9 and 87,6, respectively 6, 12 and 24 months postoperatively, ( P = 0.001). We had also observed statistically significant improvement for IKDC subjective score assessment from 47,5 preoperatively to 69,8, 74,6 and 77,2, respectively 6, 12 and 24 months follow-up with P = 0.001. Tissue filling was present but often not complete or homogenous when evaluated with MRI. The cumulative modified MOCART (magnetic resonance observation of cartilage repair tissue) results had no correlations with both clinical or subjective scores results. Conclusions Full arthroscopic AMIC technique is safe and feasible for the treatment of symptomatic knee lesions and resulted in a progressive clinical improvement. The MRI findings of the repair tissue continue to evolve during the first two years after surgery. However, the subchondral lamina and bone changes are a concern. Patients with concomitant knee procedures can also benefit from this treatment option.

A Novel Technique for Treating Cartilage Defects in the Hip: A Fully Arthroscopic Approach to Using Autologous Matrix-Induced Chondrogenesis

Microfracture is the standard of care for the treatment of small cartilage defects in the hip. Autologous matrix-induced chondrogenesis (AMIC) is a novel, 1-step approach that combines microfracture with a type I/III collagen matrix (Chondro-Gide; Geistlich Pharma AG, Wolhusen, Switzerland) to cover the microfractured defect area. The AMIC procedure has been successfully established for treating cartilage defects in the knee and talus, and we report, for the first time, its application in the hip. More importantly, at our center, we have developed a fully arthroscopic approach for the use of AMIC in the hip. Arthroscopic procedures are more desirable than open surgery because they are less invasive and hence reduce the risk of complications, such as infection or avascular necrosis of the femoral head, and allow for a shorter recovery time, resulting not only in lower overall treatment costs but also higher patient satisfaction. The arthroscopic AMIC procedure as described in this report, though surgically challenging, represents a viable, cost-effective treatment option for the repair of chondral lesions of the hip, especially when compared with autologous chondrocyte implantation.

Use of Collagen Scaffold and Autologous Bone Marrow Concentrate as a One-Step Cartilage Repair in the Knee: Histological Results of Second-Look Biopsies at 1 Year Follow-up

Chondral articular defects are a key concern in orthopaedic surgery. To overcome the disadvantages of autologous chondrocyte implantation (ACI) and to improve the outcomes of autologous matrix-induced chondrogenesis (AMIC), the latter technique is currently augmented with bone marrow concentrate injected under or seeded onto the scaffold. However, to date, only a little is known about histological outcomes of either the AMIC technique or AMIC associated with bone marrow concentrate. This study aimed to evaluate the quality of the repair tissue obtained from biopsies harvested during second-look arthroscopy after arthroscopic AMIC augmented with bone marrow concentrate. We analysed five second-look core biopsies harvested at 12 months follow-up. At the time of biopsy the surgeon reported the quality of the repair tissue using the standard ICRS Cartilage Repair Assessment (CRA). Every biopsy together with patient data was sent to our centre to undergo blind histological evaluation (ICRS II Visual Histological Assessment Scale) and data analysis. Five asymptomatic patients (mean age 43.4 years) had isolated lesions (mean size was 3.7 cm2) at the medial femoral condyle. All the implants appeared nearly normal (ICRS CRA) at arthroscopic evaluation and had a mean overall histological (ICRS II) of 59.8±14,5. Hyaline-like matrix was found in only one case, a mixture of hyaline/fibrocartilage was found in one case and fibrocartilage was found three cases. Our clinical and histological data suggest that this procedure achieved a nearly normal arthroscopic appearance and a satisfactory repair tissue, which was possibly still maturing at 12 months follow-up. Further studies are needed to understand the true potential of one-step procedures in the repair of focal chondral lesions in the knee.