Autologous Matrix-induced Chondrogenesis Procedure Research Articles

Positive outcomes following Autologous Matrix-Induced Chondrogenesis (AMIC) in the treatment of retropatellar chondral lesions: a retrospective analysis of a patient registry

BackgroundThe patellofemoral joint is a challenging environment for treating chondral defects. Among the surgical options for the treatment of chondral defects, the single-stage Autologous Matrix-Induced Chondrogenesis (AMIC) procedure uses a porcine collagen I/III membrane to enhance bone-marrow stimulation. However, longer term outcomes data are rare for this specific indication. In order to provide real-world information, an ongoing registry has been established to record patient data and outcomes when AMIC is used to treat chondral and osteochondral lesions.MethodsPatient data were retrieved from an ongoing, prospective, multisite registry of patients who had undergone AMIC treatment of chondral defects. We identified 64 patients who had undergone AMIC for patellofemoral chondral defects and for whom pre-operative and at least 1 post-operative score were available were included in this retrospective data analysis. Outcomes were assessed via the KOOS, VAS pain, and the Lysholm scores. Outcomes at the post-operative time-points were analysed using a factorial ANOVA with post-hoc testing while linear regression was used to assess associations between the change in the Lysholm score and lesion size.ResultsThere was a significant improvement in Lysholm, VAS pain, and KOOS scores from pre-operative to the 1st year post-operative (p < 0.001), and this was maintained during the follow-up.ConclusionsThe forces exerted on the patellofemoral joint make this a challenging scenario for chondral repair. Our data demonstrates that the AMIC procedure with a collagen I/III membrane is an effective treatment for retropatellar cartilage lesions, and provides reliable results, with decreased pain and improved function. Importantly, these improvements were maintained through the follow-up period.

Autologous surface repair: autologous matrix-induced chondrogenesis and minced cartilage implantation

<h2>ABSTRACT</h2><h3>Introduction</h3> The treatment of cartilage damage remains challenging. There are several procedures described. Microfracturing is considered one of the most established procedures, but long-term results are unsatisfactory, especially for larger defects. Autologous Matrix-Induced Chondrogenesis (AMIC), in which bone marrow-stimulated areas are covered with a membrane, has been introduced to address some of the limitations of microfracture with a number of long-term outcomes studies reporting satisfactory results. Minced cartilage Implantation (MCI), in which cartilage tissue is minced and inserted into cartilage defects has also been shown to have satisfactory results at 5-year results although longer-term results are still pending. <h3>Technique</h3> Both procedures can be performed arthroscopically. In the AMIC procedure, bone at the base of the chondral lesion is debrided to the subchondral plate and a bone marrow stimulation or microfracture is performed. Arthroscopic fluid is drained and the area covered with a membrane and fixed using fibrin glue or stiches either arthroscopically or using a mini-open approach. In MCI, the defect is also first debrided. Cartilage tissue removed from the affected joint is then cut into small pieces. In the open procedure, this is done with a scalpel; in the arthroscopic procedure, it is done with a shaver. The tissue is then inserted into the defcet and fixed using an allogeneic or autologous fibrin glue. <h3>Discussion</h3> AMIC and the minced cartilage technique represent a relatively simple, safe and reproducible evolution of cartilage repair techniques. Long-term studies (up to 9 years) support the satisfactory outcomes of the AMIC procedure. Five-year results for MCI procedure, report a decrease in pain and improved function, but long-term results are awaited. Well designed level one studies are now required to evaluate these techniqeus in the longer term.

Satisfactory clinical outcomes with autologous matrix-induced chondrogenesis in the treatment of grade IV chondral injuries of the knee

ObjectiveThe research aims to evaluate short- and medium-term outcomes of patients treated using autologous matrix-induced chondrogenesis (AMIC) with a hyaluronic acid scaffold (Hyalofast, Anika Therapeutics, MA, USA) in grade IV chondral lesions according to the Outerbridge classification in the knee. MethodsThis is a multicentre, non-randomized, retrospective study conducted between 2017 and 2022. To determine the clinical outcome of the patients, the follow-up was done with the subjective International Knee Documentation Committee (IKDC) score, pre-surgery, and with a follow-up at 12, 24, and 32 months. ResultsFifty patients (28 female) with a mean age of 45.9 ± 12.7 years were recruited. The mean size of the lesion was 3.5 cm2, and the injuries located in the patella (30%) and trochlear groove (24%) were the most frequent. The total IKDC clinical score significantly increased from baseline to the 32 months of follow-up with a mean difference of 36.4 (95% CI, 29.1–43.7, p < 0.001). Besides, there was a statistically significant improvement in all categories of the IKDC (symptoms, sports activities, function, and activity of daily living) compared between pre-surgery and 24 and 32 months of follow-up. The patients younger than 45 years presented better clinical outcomes than older ones with a difference between medians of 10.40 (95% CI, 1.10–11.50, p = 0.0247), and a negative correlation was found between the 32-month IKDC score and the age. In addition, no statistically significant difference was found when comparing the last results of the IKDC between patients with and without associated surgical procedures or between patients with single and several lesions, neither nor between men and women. The level of satisfaction with the procedure of all the patients, on a score of 1–10, was on average 8 ± 1.5. ConclusionResults of this study indicate that patients who underwent the AMIC procedure with hyaluronic acid scaffold for the treatment of grade IV chondral lesions in the knee presented satisfactory results throughout the follow-up. Level of evidenceLevel IV

Surgical Management of Focal Chondral Defects of the Talus: A Bayesian Network Meta-analysis

Background: No consensus has been reached regarding the optimal surgical treatment for focal chondral defects of the talus. Purpose: A Bayesian network meta-analysis was conducted to compare the clinical scores and complications of mosaicplasty, osteochondral auto- and allograft transplant, microfracture, matrix-assisted autologous chondrocyte transplant, and autologous matrix-induced chondrogenesis (AMIC) for chondral defects of the talus at midterm follow-up. Study Design: Bayesian network meta-analysis; Level of evidence, 4. Methods: This Bayesian network meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. PubMed, Embase, Google Scholar, and Scopus databases were accessed in February 2021. All clinical trials comparing 2 or more surgical interventions for the management of chondral defects of the talus were accessed. The outcomes of interest were visual analog scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, rate of failure, and rate of revision surgery. The network meta-analysis were performed through the routine for Bayesian hierarchical random-effects model analysis. The log odds ratio (LOR) effect measure was used for dichotomous variables, and the standardized mean difference (SMD) was used for continuous variables. Results: Data from 13 articles (521 procedures) were retrieved. The median length of the follow-up was 47.8 months (range, 31.7-66.8 months). Analysis of variance revealed no difference between the treatment groups at baseline in terms of age, sex, body mass index, AOFAS score, VAS score, and mean number of defects. AMIC demonstrated the greatest AOFAS score (SMD, 11.27) and lowest VAS score (SMD, –2.26) as well as the lowest rates of failure (LOR, 0.94) and revision (LOR, 0.94). The test for overall inconsistency was not significant. Conclusion: At approximately 4 years of follow-up, the AMIC procedure for management of focal chondral defects of the talus produced the best outcome.

Management of Patellar Chondral Defects with Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures: A Four Years Follow-Up Clinical Trial.

Introduction: Evidence on the management of chondral defects of the patella arises from studies in which the patellofemoral joint was treated together with the femorotibial joint and primary and revision settings. Furthermore, the superiority of Autologous Matrix Induced Chondrogenesis (AMIC) over microfractures (MFx) for patellar chondral defects is uncertain. Therefore, the present study compared primary isolated AMIC versus MFx for focal unipolar chondral defects of the patellar facet joints at midterm follow-up. Methods: Patients undergoing AMIC or isolated MFx surgery for borderline-sized focal unipolar chondral defects of the patellar facet joints were followed at our institution. All surgeries were performed in the same fashion by experienced surgeons. A parapatellar arthrotomy was adopted in all surgeries. The outcomes of interest were: Visual Analogic Scale (VAS), Tegner Activity Scale, International Knee Documentation Committee (IKDC), and the Lysholm scores. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) was assessed by a blinded radiologist, who had not been involved in the clinical management of the patients. Results: 38 patients were enrolled in the present study: 27 underwent AMIC, and 11 MFx. The mean follow-up was 45.1 months. The mean age of the patients at baseline was 34.5 years. The mean size of the defect was 2.6 cm2. The MFx cohort experienced a shorter length of the hospitalization (P = 0.008). There was no difference in terms of follow-up and previous symptoms duration, mean age, sex, side, defect size, and BMI. At last follow-up, the AMIC cohort reported greater IKDC (P = 0.01), Lysholm (P = 0.009), and Tegner (P = 0.02), along with a low rate of failure (P = 0.02). VAS was lower in the AMIC group (P = 0.002). No difference was found in the MOCART score (P = 0.09), rates of revision (P = 0.06), and arthroplasty (P = 0.2). Conclusion: The AMIC procedure achieves greater IKDC and Lysholm score, and a significant reduction of the VAS score in the management of patellar chondral defects. The Tegner scale demonstrated greater activity after AMIC procedure. Finally, the AMIC group evidenced a lower rate of failure. Similarity was found on MOCART score, rates of revision, and arthroplasty between the two procedures.

AMIC for Focal Osteochondral Defect of the Talar Shoulder.

Background: The management of a focal osteochondral lesion of the talus (OLT) is challenging. Evidence concerning the role of the autologous matrix-induced chondrogenesis (AMIC) procedure in patients with focal OLT is promising. The purpose of the present study was to investigate clinical outcomes and radiographic findings of the AMIC technique for focal unipolar OLT. Material and Methods: The present study was performed according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Twenty-four patients who underwent AMIC for focal OLT were prospectively recruited at our institution. All the surgeries were performed by two experienced surgeons through malleolar osteotomy and autologous cancellous bone grafting. The outcomes of interest were the American orthopedic foot and ankle score (AOFAS), the foot-function index (FFI), and the magnetic resonance observation of cartilage repair tissue (MOCART). Surgical duration, hospitalization length, and complications were also collected. Results: 24 patients were included in the present study. The mean follow-up was 25.17 ± 13.1 months. The mean age of the patients at surgery was 46.75 ± 15.2 years, the mean BMI 26.92 ± 5.7 kg/m2, and 50% (12 of 24) of patients were female. The right ankle was involved in 62.5% (15 of 24) of patients. The mean defect size was 6.95 ± 2.9 mm2. The mean surgical duration was 112 ± 20 min while the mean hospitalization 5.58 ± 1.7 days. At last follow-up, the AOFAS increased by 27.8 points (p < 0.0001), while the FFI reduced by 25.3 points (p < 0.0001) and the MOCART score increased by 28.33 points (p < 0.0001). No complications were observed. Conclusion: The AMIC procedure for focal osteochondral defects of the talar shoulder is feasible and reliable at midterm follow-up.

The Use of Autologous Matrix-Induced Chondrogenesis as a Surgical Treatment for Patients with the First Metatarsophalangeal Joint Osteoarthritis: Immediate and Medium-Term Results.

To demonstrate the immediate and medium-term results of the surgical treatment of patients with first metatarsophalangeal (MTP) joint osteoarthritis (OA) using the autologous matrix-induced chondrogenesis (AMIC) technique and to evaluate the effectiveness. Preoperatively the range of motion (ROM) in the first MTP joint was determined, and the following questionnaires were used: Visual Analogue Scale (VAS) of pain, American Orthopedic Foot & Ankle Society (AOFAS) score, and Functional Foot Index (FFI). All of the patients experienced a significant restriction of the ROM in the first MTP joint. The VAS of pain median was 70, AOFAS 52, and FFI 5.8. AMIC was performed in 19 patients with first MTP joint OA. All the patients experienced a significant restriction of ROM in the first MTP joint. The VAS of pain median was 70, AOFAS 52, and FFI 5.8. By the third month, VAS of pain decreased to 25, FFI to 2.2; AOFAS median increased to 77, ROM to 60°. Six months after the surgery VAS of pain decreased to 10, FFI to 1.1; AOFAS median increased to 90, ROM to 65°. After a year of observation, VAS of pain decreased to 5, FFI to 1,0; AOFAS median increased to 92.5, ROM to 71.5°. The results showed that a first MTP joint AMIC procedure can be a fairly effective method of surgical treatment that can relieve pain and significantly improve the quality of life of patients with first MTP joint OA.

Is there clinical evidence to support autologous matrix-induced chondrogenesis (AMIC) for chondral defects in the talus? A systematic review and meta-analysis

BackgroundThe aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone autologous matrix-induced chondrogenesis (AMIC) for treatment of osteochondral lesions of the talus (OCL) and compare the studies’ outcomes. MethodsPubmed and Embase were searched in January 2020 for articles concerning OCL surgery. Studies were included if they had a minimum 1-year follow-up and the primary measures were functional outcomes. The meta-analysis compared the Visual Analogic Score (VAS), the American Orthopedic Foot and Ankle Score (AOFAS), and the Foot Function Index (FFI) between baseline and follow-up of 1−2years, and 3−5years. A random effects model was used to evaluate outcome changes. ResultsThe search returned 15 studies, with a total of 492 patients. The VAS improved 4.45 and 4.6 points from baseline to the 1−2year and 3−5yearfollow-up, respectively (p<0.001). AOFAS improved 31.59 and 32.47 points from baseline to the 1−2year and 3−5yearfollow-up, respectively (p<0.001). The FFI showed a significant improvement of 30.93 points from baseline to year 3−5 (p<0.001). A total of 6 patients with revision surgeries have been reported within the follow up period. It was not possible to correlate clinical features like lesion size, surgical approach, and bone marrow stimulation technique to the reported outcome. ConclusionSurgical treatment of OCL via the AMIC procedure provided significant improvement in the functional outcome and pain scores when compared to the pre-operative values. Improvements were observed up to 5years post-operatively.

Early to medium term outcomes of osteochondral lesions of the talus treated by autologous matrix induced chondrogenesis (AMIC)

BackgroundThe primary aim of the study is to evaluate the functional outcome following AMIC procedure in patients with osteochondral injury of the talus. The secondary aim is to evaluate if size of the lesion and patient's age influence outcome. Materials and methodsThis is a retrospective study of 25 patients who underwent AMIC procedure of the talus treated by a single surgeon. Functional outcomes were evaluated using pre and post operative AOFAS and VAS scores. ResultsThe mean lesion size was 1.74 cms with 88% of lesions in the study more than 1.4 cms. There was a significant improvement in AOFAS score with mean improvement of 49.40 (p < 0.05) and VAS score of 5.36 (p < 0.05). We could not find any correlation between either age or lesion size with functional outcome for AMIC procedure. ConclusionAMIC procedure seems to be a reliable treatment method for larger diameter osteochondral lesions of the talus up to 2.5 cms in diameter.

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.

Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study

Background: Autologous matrix-induced chondrogenesis (AMIC) has become an interesting treatment option for osteochondral lesions of the talus (OLTs) with promising clinical short- to midterm results. Purpose: To investigate the clinical and radiological outcome of the AMIC procedure for OLTs, extending the follow-up to 8 years. Study Design: Case series; Level of evidence, 4. Methods: Thirty-three patients (mean age, 35.1 years; body mass index, 26.8) with osteochondral lesions of the medial talar dome were retrospectively evaluated after open AMIC repair at a mean follow-up of 4.7 years (range, 2.3-8.0 years). Patients requiring additional surgical procedures were excluded. All OLTs (mean size, 0.9 cm2; range, 0.4-2.3 cm2) were approached through a medial malleolar osteotomy, and 28 patients received subchondral autologous bone grafting. Data analysis included the visual analog scale for pain, the American Orthopaedic Foot and Ankle Society score for ankle function, the Tegner score for sports activity, and the MOCART (magnetic resonance observation of cartilage repair tissue) scoring system for repair cartilage and subchondral bone evaluation. Results: Mean ± SD visual analog scale score improved significantly from 6.4 ± 1.9 preoperatively to 1.4 ± 2.0 at latest follow-up (P < .001). The mean American Orthopaedic Foot and Ankle Society score was 93.0 ± 7.5 (range, 75-100). The Tegner score improved significantly from 3.5 ± 1.8 preoperatively to 5.2 ± 1.7 at latest follow-up (P < .001), and 79% returned to their previous sports levels. The MOCART score averaged 60.6 ± 21.2 (range, 0-100). Complete filling of the defect was seen in 88% of cases, but 52% showed hypertrophy of the cartilage layer. All but 1 patient showed persistent subchondral bone edema. The patient’s age and body mass index, the size of the osteochondral lesion, and the MOCART score did not show significant correlation with the clinical outcome. There were no cases of revision surgery for failed AMIC. Fifty-eight percent underwent reoperation, mainly for symptomatic hardware after malleolar osteotomy. Conclusion: AMIC for osteochondral talar lesions led to significant pain reduction, recovery of ankle function, and successful return to sport. The MOCART score did not correlate with the good clinical results; the interpretation of postoperative imaging remains therefore challenging.

Acetabular Chondral Lesions Associated With Femoroacetabular Impingement Treated by Autologous Matrix-Induced Chondrogenesis or Microfracture: A Comparative Study at 8-Year Follow-Up

The aim of this retrospective study was to investigate, at 8years, the clinical follow-up and failure rate (revision rate/conversion to arthroplasty) of patients with hip chondral lesions associated with femoroacetabular impingement and to compare over time the treatment by microfracture (MFx) and autologous matrix-induced chondrogenesis (AMIC). Patients aged between 18 and 55years, with acetabular grade III and IV chondral lesions (Outerbridge), measuring 2 to 8cm2 operated on at least 8years before enrollment. Exclusion criteria were rheumatoid arthritis, dysplasia, or axial deviation of the femoral head. There were no arthritic lesions, Tonnis < 2, or joint space of at least 2mm. MFx was performed with an awl, and the Chondro-Gide membrane used for the AMIC procedure was placed without glue. Outcomes used modified Harris hip score (mHHS) at 6months and yearly for 8years and patient acceptable symptomatic state. Among 130 patients, 109 fulfilled inclusion criteria. Fifty were treated by MFx and 59 by AMIC. The mHHS significantly improved in both groups from 46 ± 6.0 to 78 ± 8.8 for mHHS at 6-12months, even for lesions > 4cm2. From 2 to 8years, mHHS in the AMIC group was better than in the MFx group (P < .005). This mHHS improvement in the AMIC group was maintained through the 8-year follow-up period, whereas it deteriorated after 1year in the MFx group (P < .005). Eleven patients (22%) in the MFx group required total hip arthroplasty (THA); none in the AMIC group did. Patient acceptable symptomatic state analysis confirmed similar short-term improvement, but a significant (P < .007) degradation after 2-8years in MFx patients. MFx and AMIC techniques led to marked clinical short-term improvement in patients with chondral defects resulting from femoroacetabular impingement in the first 2years. However, AMIC gave significantly better results as measured by mHHS, which were maintained after 8years, the results of MFx in the hip deteriorated over time with 22% of patients undergoing conversion to THA. No patient in the AMIC group was converted to THA; the results of AMIC appeared stable over time and independent of lesion size. III, retrospective patient group study.

Open reconstruction with autologous spongiosa grafts and matrix-induced chondrogenesis for osteochondral lesions of the talus can be performed without medial malleolar osteotomy.

To evaluate complication rates and postoperative outcomes in patients with osteochondral lesions of the talus who underwent an autologous matrix-induced chondrogenesis (AMIC) procedure with autologous spongiosa grafting without malleolar osteotomy. A total of 23 patients with a mean age of 35.6 ± 13.9years were included in this study. The mean follow-up was 33.5 ± 10.4months (range 24-52.9months). The clinical outcomes were evaluated using the visual analog scale (VAS) and the Foot Function Index (FFI). Postoperatively, lesion healing was assessed using the magnetic resonance observation of cartilage repair tissue (MOCART) protocol. There were no intraoperative or perioperative complications. In one patient, arthroscopic arthrolysis was performed due to painful arthrofibrosis. The mean VAS significantly decreased from 7.6 ± 1.1 (range 4.2-9.3) to 1.4 ± 2.2 (range 0-7.4) (P < 0.001). The mean FFI significantly improved from 46.8 ± 14.3 (range 24.3-80.8) to 15.9 ± 11.4 (range 10.0-51.7) (P < 0.001). The mean MOCART score at 1-year follow-up was 74.1 ± 12.4 (range 50-95). Both preoperative and postoperative pains were significantly higher for smokers when compared to non-smokers. The results of the present study study indicate that AMIC procedure can be performed through the anterolateral and anteromedial arthrotomy without malleolar osteotomy. Thus, the possible complications associated with malleolar osteotomy can be avoided. The AMIC procedure without a malleolar osteotomy can be considered a safe and reliable procedure in patients with osteochondral lesions localized anterior to the midline in the sagittal plane. Therapeutic case series, Level IV.

Cartilage Surgery in Overweight Patients: Clinical and MRI Results after the Autologous Matrix-Induced Chondrogenesis Procedure.

Modern orthopaedic surgery provides a variety of techniques for cartilage repair. The Autologous Matrix-Induced Chondrogenesis (AMIC) procedure is a single-step technique with a collagen I/III scaffold for the treatment of full-thickness cartilage lesions. The aim of the study was to analyze the outcome of the AMIC procedure in overweight patients with knee cartilage defects. Overweight patients treated with AMIC surgery were followed up by clinical and MRI examination. 9 patients with a cartilage defect of the knee with a mean lesion size of 2.1 ± 1.2 cm2 and an average body mass index (BMI) of 29.3 were available for the follow-up. The Lysholm Score was significantly improved by the AMIC procedure (38 to 67, p ≤ 0.008). The VAS Score was significantly lower after the procedure (9 to 3, p ≤ 0.018). In the postoperative MOCART Scale, the scaffold reached defect covering of 80%. However, 2 patients had to be revised due to persisting knee pain. The AMIC procedure enhances pain reduction and gain of knee function for cartilage defects of overweight patients. However, in cases of an increased BMI, the patient had to be informed that success rate is reduced despite good defect covering.

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.

Functional Medium-Term Results After Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 5-Year Prospective Cohort Study

Autologous matrix-induced chondrogenesis (AMIC) has gained popularity in the treatment of osteochondral lesions of the talus. Previous studies have presented promising short-term results for AMIC talar osteochondral lesion repair, a 1-step technique using a collagen type I/III bilayer matrix. The aim of the present study was to investigate the mid-term effects. The 5-year results of a prospective cohort study are presented. All patients underwent an open AMIC procedure for a talar osteochondral lesion. Data analysis included general demographic data, preoperative magnetic resonance imaging findings, intraoperative details, and German version of the Foot Function Index (FFI-D) scores preoperatively and at 1 and 5 years after surgery. The primary outcome variable was the longitudinal effect of the procedure, and the influence of various variables on the outcome was tested. Of 47 consecutive patients, 21 (45%) were included. Of the 21 patients, 8 were female (38%) and 13 were male (62%), with a mean age of 37 ± 15 (range 15 to 62) years and a body mass index of 26 ± 5 (range 20 to 38) kg/m2. The defect size was 1.4 ± 0.9 (range 0.2 to 4.0) cm2. The FFI-D decreased significantly from preoperatively to 1 year postoperatively (56 ± 18 versus 33 ± 25; p = .003), with a further, nonsignificant decrease between the 1- and 5-year follow-up examination (33 ± 25 versus 24 ± 21; p = .457). Similar results were found for the FFI-D subscales of function and pain. The body mass index and lesion size showed a positive correlation with the preoperative FFI-D overall and subscale scores. These results showed a significant improvement in pain and function after the AMIC procedure, with a significant return to sports by the 5-year follow-up point. The greatest improvement overall was seen within the first year; however, further clinical satisfaction among the patients was noticeable after 5 years.

Arthroscopic treatment of chondral defects in the hip: AMIC, MACI, microfragmented adipose tissue transplantation (MATT) and other options.

Chondral lesions are currently considered in the hip as a consequence of trauma, osteonecrosis, dysplasia, labral tears, loose bodies, dislocation, previous slipped capital femoral epiphysis and Femoro-Acetabular-Impingement (FAI). The management of chondral lesions is debated and several techniques are described. The physical examination must be carefully performed, followed by radiographs and magnetic resonance imaging (MRI). Differential diagnosis with other pathologies must be considered. Debridement is indicated in patients younger than 50 years with a chondropathy of 1st or 2nd degree. Microfractures are indicated in patients younger than 50 years with a chondropathy of 3rd or 4th degree less than 2 cm2. Matrix-Induced Autologous Chondrocyte Implantation (MACI) and Autologous Matrix-Induced Chondrogenesis (AMIC) procedures are indicated in patients with full-thickness symptomatic 3rd–4th degree chondral defects, extended 2 cm2 or more. The AMIC procedure has the advantage of a one-step procedure and much less expense. Microfragmented adipose tissue transplantation (MATT) is indicated for the treatment of delamination and 1st and 2nd degree chondral lesions, regardless of the age of the patient. Chondral defects are effective when the joint space is not compromised. When the Tonnis classification is two or greater, treatment of chondral lesions should be considered ineffective.

Combining a novel leucocyte-platelet-concentrated membrane and an injectable collagen scaffold in a single-step AMIC procedure to treat chondral lesions of the knee: a preliminary retrospective study.

Different surgical approaches are currently available to treat knee chondral defects. Microfracture is the most commonly applied, but it often leads to a mechanically inferior fibrocartilaginous tissue. To overcome this shortcoming, the Autologous, Matrix-Induced Chondrogenesis (AMIC) technique has been proposed. To further enhance the outcome of AMIC, the addition of haemoderivatives containing growth factors that stimulate cartilage healing has emerged as a new treatment method. Recently, a novel leucocyte-platelet-concentrated membrane (CLP-MB), highly enriched in platelets, monocytes/macrophages, fibrinogen, CD34+ and CD34+VEGFR-2+CD133+ cells, has been developed. Additionally, an injectable collagen scaffold (Cartifill) has been proposed as a replacement of the AMIC standard collagen membrane. This preliminary study is aimed to evaluate the short-term safety and efficacy of the use of the CLP-MB membrane and injectable collagen scaffold when combined in single-step AMIC procedures for the treatment of knee chondral lesions. Medical records of patients who underwent an AMIC procedure with the CLP-MB membrane combined with Cartifill were reviewed retrospectively. Follow-up assessments were conducted at 6 and 12months after surgery. Clinical function was assessed on the basis of the International Knee Documentation Committee (IKDC) score. Pain was evaluated using the visual analogue scale (VAS). Twenty-five patients were identified as meeting the inclusion criteria. Mean IKDC and VAS scores significantly improved during the follow-up time. The postoperative course was uneventful. AMIC combined with the CLP-MB membrane, and Cartifill seems to be a promising approach to treat knee chondral defects.

Sports Activity After Reconstruction of Osteochondral Lesions of the Talus With Autologous Spongiosa Grafts and Autologous Matrix-Induced Chondrogenesis

Background: For the treatment of osteochondral lesions of the talus (OCLTs), autologous matrix-induced chondrogenesis (AMIC) is a safe 1-step procedure with good clinical and radiological results. However, data regarding postoperative sports activity after AMIC are limited. Purpose: To identify significant factors influencing the rate of postoperative sports and recreational activities. Study Design: Case series; Level of evidence, 4. Methods: The sports and recreational activities of 60 patients (mean age, 34.9 ± 11.5 years) undergoing the AMIC procedure were retrospectively analyzed at a mean of 46.9 ± 17.8 months (range, 24.5-87.0 months) postoperatively. The visual analog scale (VAS) for pain score, Tegner activity scale score, activity rating scale (ARS) score, and satisfaction with surgery outcomes were assessed. Results: Corrective calcaneal osteotomy was performed in 38 of 60 (63.3%) patients. Ligament repair was performed in 41 of 60 (68.3%) patients. The mean VAS score improved significantly from 6.9 ± 1.6 points (range, 5-10 points) preoperatively to 2.3 ± 1.9 points (range, 0-6 points) at latest follow-up (P < .001). No significant change in the mean Tegner activity scale score (3.3 ± 2.0 preoperatively to 3.4 ± 2.2 postoperatively; P = .526) and the mean ARS score (2.6 ± 4.3 preoperatively to 2.3 ± 3.4 postoperatively; P = .874) was noted. The percentage of patients involved in sports activity before the onset of symptoms became significantly lower at the time of surgery (from 95.0% to 53.3%; P < .001); no significant difference was noted postoperatively (from 53.3% to 58.3%; P = .663). No significant difference of the weekly sports frequency and the duration of sports activity was found postoperatively. Conclusion: Patients undergoing AMIC repair of an OCLT participate at a similar low postoperative sports and recreational activity level compared with the preoperative level.

4–5 Year results following AMIC procedure with collagen matrix in cartilage reconstruction of the talus

Category:Ankle, ArthroscopyIntroduction/Purpose:In recent years, the autologous matrix-induced chondrogenesis (AMIC) has established itself in the treatment of cartilage defects of the talus. In th...