PMID- 38426599
OWN - NLM
STAT- MEDLINE
DCOM- 20240403
LR  - 20240403
IS  - 1433-7347 (Electronic)
IS  - 0942-2056 (Linking)
VI  - 32
IP  - 4
DP  - 2024 Apr
TI  - The role of autologous bone grafting in matrix-associated autologous chondrocyte 
      implantation at the knee: Results from the German Cartilage Registry 
      (KnorpelRegister DGOU).
PG  - 929-940
LID - 10.1002/ksa.12106 [doi]
AB  - PURPOSE: To investigate whether concomitant autologous bone grafting adversely 
      affects clinical outcome and graft survival after matrix-associated autologous 
      chondrocyte implantation (M-ACI). METHODS: The present study examines registry 
      data of patients who underwent M-ACI with or without autologous bone grafting for 
      large-sized chondral or osteochondral defects. Propensity score matching was 
      performed to exclude potential confounders. A total of 215 patients with similar 
      baseline characteristics were identified. Clinical outcome was assessed at the 
      time of surgery and at 6, 12, 24, 36 and 60 months using the Knee Injury and 
      Osteoarthritis Outcome Score (KOOS). KOOS change, clinical response rate, KOOS 
      subcomponents and failure rate were determined. RESULTS: Patients treated with 
      M-ACI and autologous bone grafting achieved comparable clinical outcomes compared 
      with M-ACI alone. At 24 months postoperatively, the patient-reported outcome 
      (PRO) of patients treated with M-ACI and autologous bone grafting was even 
      significantly better as measured by KOOS (74.9 +/- 18.8 vs. 79.2 +/- 15.4; 
      p = 0.043). However, the difference did not exceed the minimal clinically 
      important difference (MCID). In patients with M-ACI and autologous bone grafting, 
      a greater change in KOOS relative to baseline was observed at 6 (9.3 +/- 14.7 vs. 
      15.0 +/- 14.7; p = 0.004) and 12 months (12.6 +/- 17.2 vs. 17.7 +/- 14.6; p = 0.035). 
      Overall, a high clinical response rate was observed in both groups at 24 months 
      (75.8% vs. 82.0%; p = n.s.). The estimated survival at the endpoint of 
      reoperation for any reason was 82.1% (SD 2.8) at 8.4 years for isolated M-ACI and 
      88.7% (SD 2.4) at 8.2 years for M-ACI with autologous bone grafting (p = 0.039). 
      CONCLUSIONS: Even in the challenging cohort of large osteochondral defects, the 
      additional treatment with autologous bone grafting leads to remarkably good 
      clinical outcomes in patients treated with M-ACI. In fact, they tend to benefit 
      more from surgery, have lower revision rates and achieve clinical response rates 
      earlier. Subchondral bone management is critical to the success of M-ACI and 
      should be addressed in the treatment of borderline defects. LEVEL OF EVIDENCE: 
      Level III.
CI  - (c) 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by 
      John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee 
      Surgery and Arthroscopy.
FAU - Weishorn, Johannes
AU  - Weishorn J
AUID- ORCID: 0000-0003-2031-7411
AD  - Department of Orthopaedics, Heidelberg University Hospital, 
      Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
FAU - Tischer, Thomas
AU  - Tischer T
AD  - Malteser Waldkrankenhaus St. Marien, Erlangen, Germany.
AD  - Department of Orthopaecdics, University Medical Center Rostock, Rostock, Germany.
FAU - Niemeyer, Philipp
AU  - Niemeyer P
AD  - OCM Orthopedic Surgery Munich, Munich, Germany.
AD  - Clinic for Orthopedics and Trauma Surgery, Albert-Ludwigs-University Freiburg, 
      Freiburg im Breisgau, Germany.
FAU - Renkawitz, Tobias
AU  - Renkawitz T
AD  - Department of Orthopaedics, Heidelberg University Hospital, 
      Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
FAU - Bangert, Yannic
AU  - Bangert Y
AUID- ORCID: 0000-0001-8392-7829
AD  - Department of Orthopaedics, Heidelberg University Hospital, 
      Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
LA  - eng
GR  - None/
PT  - Journal Article
DEP - 20240301
PL  - Germany
TA  - Knee Surg Sports Traumatol Arthrosc
JT  - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
JID - 9314730
SB  - IM
MH  - Humans
MH  - *Chondrocytes/transplantation
MH  - Bone Transplantation
MH  - *Cartilage, Articular/surgery
MH  - Knee Joint/surgery
MH  - Transplantation, Autologous/methods
MH  - Registries
OTO - NOTNLM
OT  - ACI
OT  - autologous bone grafting
OT  - cartilage
OT  - knee
OT  - osteochondral defects
OT  - registry
EDAT- 2024/03/01 12:43
MHDA- 2024/04/03 06:44
CRDT- 2024/03/01 08:14
PHST- 2024/02/07 00:00 [revised]
PHST- 2024/01/07 00:00 [received]
PHST- 2024/02/12 00:00 [accepted]
PHST- 2024/04/03 06:44 [medline]
PHST- 2024/03/01 12:43 [pubmed]
PHST- 2024/03/01 08:14 [entrez]
AID - 10.1002/ksa.12106 [doi]
PST - ppublish
SO  - Knee Surg Sports Traumatol Arthrosc. 2024 Apr;32(4):929-940. doi: 
      10.1002/ksa.12106. Epub 2024 Mar 1.