Does Sex Matter? Analysis Of Results At 5 Years After Matrix-assisted Autologous Chondrocyte Transplantation In A Large Cohort Of Patients

OBJECTIVES: The main purpose was to document and analyze the influence of sex on the clinical outcome in a large cohort of patients treated with a cartilage regenerative procedure for knee chondral lesions and prospectively followed at medium-term follow-up. METHODS: 250 knees have been treated with matrix-assisted autologous chondrocyte transplantation (MACT) and prospectively evaluated at 1, 2, and minimum 5-year follow-up. The patients were 182 men and 68 women affected by focal International Cartilage Repair Society (ICRS) grade III-IV chondral knee defects involving femoral condyles, trochleae and patellae. Two homogeneous groups of 56 patients each have been selected by a blinded independent statistician for a case-control comparative analysis. The clinical outcome was analysed using the Cartilage standard Evaluation Form as proposed by ICRS and the Tegner score. RESULTS: After the treatment, a statistically significant improvement in all the scores was observed in both groups. The IKDC subjective score showed better results for men at all follow-ups in the general population: 79.5±18.6 vs 64.3±20.2 for men and women respectively (p<0.0005) at 5 years; the same trend was confirmed by EQ-VAS and Tegner scores. The case control analysis with scores standardized according to the specific patient category didn’t confirm the sex related difference and did not show any statistically significant difference at all follow-ups between men and women. Etiology, lesion site and pre-injury activity level differ in women and men affected by cartilage lesions and are responsible for the difference in the final outcome of the general population. CONCLUSION: Women have a different chondral lesion pattern; more frequently they present unfavorable conditions related to etiology, site and activity level; they also reach lower not normalized scores. However, a case-control analysis with normalized data for the specific patient's categories showed that on equal terms women have the same success possibilities than men after a surgical treatment for knee cartilage regeneration.