Matrix-induced Chondrogenesis Research Articles

Bony Union of Osteochondral Lesion of the Talus after Bone Marrow Aspirate Concentrate and Matrix-Induced Chondrogenesis: A Case Report

Bony Union of Osteochondral Lesion of the Talus after Bone Marrow Aspirate Concentrate and Matrix-Induced Chondrogenesis: A Case Report

Cartilage Restoration for Isolated Patellar Chondral Defects: An Updated Systematic Review.

Patellar chondral lesions can be particularly challenging to manage in younger and more active populations. To synthesize, organize, and summarize the results and complication rates of various patellar cartilage restoration techniques. Systematic review; Level of evidence, 4. We performed this systematic review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the Medline, Embase, Scopus, and Cochrane databases. Studies were included that reported on surgical treatment of patellar chondral defects with ≥5 patients and 12 months of follow-up data. Relevant demographic data from the included studies were extracted, and patient-reported outcome scores, visual analog scale for pain results, return-to-sport rate, complications, and concomitant procedures were documented. There were 24 studies that met the inclusion criteria, with a total of 575 patients (male, n = 239; female, n = 336). In total, 6 surgical techniques were utilized. In 9 studies, the surgical procedure of choice was osteochondral autograft transplantation (OAT); 8 studies evaluated autologous chondrocyte implantation (ACI); 3 evaluated advanced microfracture/autologous matrix-induced chondrogenesis; 1 evaluated osteochondral allograft transplantation (OCA); 1 evaluated particulate juvenile articulated cartilage; and 2 evaluated a synthetic osteochondral graft. No uniform functional outcome score or assessment was utilized across studies. OAT was predominantly used for smaller chondral lesions (<2 cm2) and demonstrated minimal complication rates and satisfactory outcome scores. Advanced microfracture techniques showed promise, with improvement in outcome scores and zero complications. Matrix-induced ACI consistently exhibited higher mean improvement in the measured outcome scores and resulted in fewer complications when compared with previous generations of ACI. OAT and ACI were the most studied procedures for isolated patellar chondral defects. Advanced microfracture techniques showed promise, but indications (ie, size) and variability in techniques need to be elucidated in higher-level studies. Further prospective studies comparing OCA and matrix-induced ACI for larger patellar defects are necessary to determine the superior technique.

Does the Choice of Acellular Scaffold and Augmentation With Bone Marrow Aspirate Concentrate Affect Short-term Outcomes in Cartilage Repair? A Systematic Review and Meta-analysis

Background: Matrix-induced chondrogenesis (MIC) is a promising treatment option for critical-size cartilage lesions of the knee; however, there exists substantial heterogeneity in the choice of acellular scaffold matrix for MIC cartilage repairs. Hypothesis: The choice of acellular matrix will not affect patient outcomes after MIC cartilage repair procedures, and the addition of concentrated bone marrow aspirate (cBMA) will improve short-term patient outcomes regardless of matrix choice. Study Design: Meta-analysis; Level of evidence, 4. Methods: Studies were stratified by matrix type: multilayered, single layered, and gel based. Continuous outcomes were analyzed with pairwise meta-analysis using the inverse variance model with random effects applied. Binary outcomes were analyzed as pooled proportions in a single-arm fashion; after which, reconstruction of relative risks (RRs) with confidence intervals was performed using the Katz logarithmic method. Results: A total of 876 patients were included: 469 received multilayered bioscaffolds; 238, gel-based scaffolds; and 169, single-layered scaffolds. The mean age of patients was 36.2 years (95% CI, 33.9 to 38.4), while the mean lesion size was 3.91 cm2 (95% CI, 3.40 to 4.42). The weighted mean follow-up was 23.8 months (95% CI, 20.1 to 27.6). Multilayered bioscaffolds were most effective at improving visual analog scale scores (P = .03; weighted mean difference [WMD], −4.44 [95% CI, −4.83 to −4.06]; P < .001). There were significantly lower risks of incomplete defect filling for gel-based scaffolds when compared with multilayered scaffolds (RR, 0.78 [95% CI, 0.69 to 0.88]; P < .001) and single-layered scaffolds (RR, 0.58 [95% CI, 0.41 to 0.81]; P = .001). Augmentation with cBMA further improved clinical scores across all scaffolds, with significant improvements in Tegner score (P = .02), while decreasing incomplete defect filling rates as well. There was significantly greater improvement in visual analog scale scores (P = .01) for single-layered scaffolds with cBMA augmentation (WMD, −4.88 [95% CI, −5.38 to −4.37]; P < .001) as compared with single-layered scaffolds without cBMA augmentation (WMD, −4.08 [95% CI, −4.46 to −3.71]; P < .001). All significant improvements were below their respective minimum clinically important differences. Conclusion: While cartilage repair with acellular scaffolds provides significant improvements in pain and function for patients, there is insufficient clinical evidence to suggest which scaffold material is the most superior in influencing such improvements. The enhancement of cartilage repair procedures with cBMA may provide further functional improvements and improve defect filling; however, more long-term evidence is required to evaluate the effects.

Outcomes of bone marrow aspirate concentrate and matrix-induced chondrogenesis (BMIC) for treatment of osteochondral lesions of the talus

BackgroundTo analyze the outcomes of Bone marrow aspirate concentrate and Matrix-Induced Chondrogenesis (BMIC) in Osteochondral Lesions of the Talus (OLTs). MethodsPatients with OLTs treated with BMIC from June 2013 to July 2020 were included. Visual Analogue Scale (VAS), Foot Function Index (FFI), and Foot Ankle Outcome Score (FAOS) before treatment and at last follow-up were subjected to analysis. ResultsForty-five patients were included and mean follow-up was 39.1 months (range, 13–97 months). Mean lesion size and depth were 180.7 ± 110.4 mm2 and 9.6 ± 3.7 mm, respectively. BMIC was performed without malleolar osteotomy in 36 patients (80%) and bone graft was performed in 42 (93.3%). VAS, FFI, and FAOS improved significantly. No complication occurred and no revision was required. ConclusionsThe BMIC procedure is feasible and should be considered a viable treatment option for OLTs associated with large subchondral bone defects.

Corrigendum: Operative Treatment for Osteochondral Lesions of the Talus: Bone Marrow Aspirate Concentrate and Matrix-induced Chondrogenesis

Corrigendum: Operative Treatment for Osteochondral Lesions of the Talus: Bone Marrow Aspirate Concentrate and Matrix-induced Chondrogenesis

Operative Treatment for Osteochondral Lesions of the Talus: Bone Marrow Aspirate Concentrate and Matrix-induced Chondrogenesis

Operative Treatment for Osteochondral Lesions of the Talus: Bone Marrow Aspirate Concentrate and Matrix-induced Chondrogenesis

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.

Enhanced microfracture techniques in cartilage knee surgery: Fact or fiction?

The limited intrinsic healing potential of human articular cartilage is a well-known problem in orthopedic surgery. Thus a variety of surgical techniques have been developed to reduce joint pain, improve joint function and delay the onset of osteoarthritis. Microfractures as a bone marrow stimulation technique present the most common applied articular cartilage repair procedure today. Unfortunately the deficiencies of fibrocartilaginous repair tissue inevitably lead to breakdown under normal joint loading and clinical results deteriorate with time. To overcome the shortcomings of microfracture, an enhanced microfracture technique was developed with an additional collagen I/III membrane (Autologous, Matrix-Induced Chondrogenesis, AMIC(®)). This article reviews the pre-clinical rationale of microfractures and AMIC(®), presents clinical studies and shows the advantages and disadvantages of these widely used techniques. PubMed and the Cochrane database were searched to identify relevant studies. We used a comprehensive search strategy with no date or language restrictions to locate studies that examined the AMIC(®) technique and microfracture. Search keywords included cartilage, microfracture, AMIC(®), knee, Chondro-Gide(®). Besides this, we included our own experiences and study authors were contacted if more and non published data were needed. Both cartilage repair techniques represent an effective and safe method of treating full-thickness chondral defects of the knee in selected cases. While results after microfracture deteriorate with time, mid-term results after AMIC(®) seem to be enduring. Randomized studies with long-term follow-up are needed whether the grafted area will maintain functional improvement and structural integrity over time.

CELL TECHNOLOGIES AND TISSUE ENGINEERING IN THE TREATMENTOF ARTICULAR CHONDRAL DEFECTS

A review of literature considers the problem of hyaline cartilage biology and repair following by injury, and surgical repair of cartilage defects. Repair techniques based on direct cartilage substitution (mosaicplasty, osteochondral allotransplantation, minced cartilage autotransplantation in gel), bone morrow stimulation techniques (abrasion, drilling, microfracture, matrix-induced chondrogenesis) were characterized in terms of biology and clinics. Most attention was addressed to cell technology and tissue engineering.