Cargando…
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 m...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918926/ https://www.ncbi.nlm.nih.gov/pubmed/33668454 http://dx.doi.org/10.3390/life11020141 |
_version_ | 1783658033900945408 |
---|---|
author | Migliorini, Filippo Eschweiler, Jörg Maffulli, Nicola Driessen, Arne Rath, Björn Tingart, Markus Schenker, Hanno |
author_facet | Migliorini, Filippo Eschweiler, Jörg Maffulli, Nicola Driessen, Arne Rath, Björn Tingart, Markus Schenker, Hanno |
author_sort | Migliorini, Filippo |
collection | PubMed |
description | 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 cm(2). 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. |
format | Online Article Text |
id | pubmed-7918926 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-79189262021-03-02 Management of Patellar Chondral Defects with Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures: A Four Years Follow-Up Clinical Trial Migliorini, Filippo Eschweiler, Jörg Maffulli, Nicola Driessen, Arne Rath, Björn Tingart, Markus Schenker, Hanno Life (Basel) Communication 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 cm(2). 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. MDPI 2021-02-13 /pmc/articles/PMC7918926/ /pubmed/33668454 http://dx.doi.org/10.3390/life11020141 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Communication Migliorini, Filippo Eschweiler, Jörg Maffulli, Nicola Driessen, Arne Rath, Björn Tingart, Markus Schenker, Hanno Management of Patellar Chondral Defects with Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures: A Four Years Follow-Up Clinical Trial |
title | Management of Patellar Chondral Defects with Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures: A Four Years Follow-Up Clinical Trial |
title_full | Management of Patellar Chondral Defects with Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures: A Four Years Follow-Up Clinical Trial |
title_fullStr | Management of Patellar Chondral Defects with Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures: A Four Years Follow-Up Clinical Trial |
title_full_unstemmed | Management of Patellar Chondral Defects with Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures: A Four Years Follow-Up Clinical Trial |
title_short | Management of Patellar Chondral Defects with Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures: A Four Years Follow-Up Clinical Trial |
title_sort | management of patellar chondral defects with autologous matrix induced chondrogenesis (amic) compared to microfractures: a four years follow-up clinical trial |
topic | Communication |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918926/ https://www.ncbi.nlm.nih.gov/pubmed/33668454 http://dx.doi.org/10.3390/life11020141 |
work_keys_str_mv | AT migliorinifilippo managementofpatellarchondraldefectswithautologousmatrixinducedchondrogenesisamiccomparedtomicrofracturesafouryearsfollowupclinicaltrial AT eschweilerjorg managementofpatellarchondraldefectswithautologousmatrixinducedchondrogenesisamiccomparedtomicrofracturesafouryearsfollowupclinicaltrial AT maffullinicola managementofpatellarchondraldefectswithautologousmatrixinducedchondrogenesisamiccomparedtomicrofracturesafouryearsfollowupclinicaltrial AT driessenarne managementofpatellarchondraldefectswithautologousmatrixinducedchondrogenesisamiccomparedtomicrofracturesafouryearsfollowupclinicaltrial AT rathbjorn managementofpatellarchondraldefectswithautologousmatrixinducedchondrogenesisamiccomparedtomicrofracturesafouryearsfollowupclinicaltrial AT tingartmarkus managementofpatellarchondraldefectswithautologousmatrixinducedchondrogenesisamiccomparedtomicrofracturesafouryearsfollowupclinicaltrial AT schenkerhanno managementofpatellarchondraldefectswithautologousmatrixinducedchondrogenesisamiccomparedtomicrofracturesafouryearsfollowupclinicaltrial |