KNEE
Matrix-induced autologous chondrocyte implantation versus
microfracture in the treatment of cartilage defects of the knee:
a 2-year randomised study
Erhan Basad
•
Bernd Ishaque
•
Georg Bachmann
•
Henning Stu
¨
rz
•
Ju
¨
rgen Steinmeyer
Received: 12 May 2009 / Accepted: 10 December 2009 / Published online: 9 January 2010
Ó Springer-Verlag 2010
Abstract Cartilage defects occur in approximately 12%
of the population and can result in significant function
impairment and reduction in quality of life. Evidence for
the variety of surgical treatments available is inconclusive.
This study aimed to compare the clinical outcomes of
patients with symptomatic cartilage defects treated with
matrix-induced autologous chondrocyte implantation
(MACI
TM
or microfracture (MF). Included patients were
C18 and B50 years of age with symptomatic, post-trau-
matic, single, isolated chondral defects (4–10 cm
2
)
and were randomised to receive MACI
TM
or MF. Patients
were followed up 8–12, 22–26 and 50–54 weeks post-
operatively for efficacy and safety evaluation. Outcome
measures were the Tegner, Lysholm and ICRS scores.
Sixty patients were included in a randomised study
(40 MACI
TM
, 20 MF). The difference between baseline
and 24 months post-operatively for both treatment groups
was significant for the Lysholm, Tegner, patient ICRS and
surgeon ICRS scores (all P \ 0.0001). However, MACI
TM
was significantly more effective over time (24 months
versus baseline) than MF according to the Lysholm
(P = 0.005), Tegner (P = 0.04), ICRS patient (P = 0.03)
and ICRS surgeon (P = 0.02) scores. There were no safety
issues related to MACI
TM
or MF during the study.
MACI
TM
is superior to MF in the treatment of articular
defects over 2 years. MACI
TM
and MF are complementary
procedures, depending on the size of the defect and
symptom recurrence. The MACI
TM
technique represents a
significant advance over both first and second generation
chondrocyte-based cartilage repair techniques for surgeons,
patients, health care institutions and payers in terms of
reproducibility, safety, intraoperative time, surgical sim-
plicity and reduced invasiveness.
Keywords Knee Á Cartilage Á Autologous
transplantation Á Arthroscopic microfracture Á
Matrix induced chondrocyte implantation (MACI)
Introduction
The exact incidence of cartilage defects in the knee is not
known, but a prevalence of between 11 and 63% has been
reported in patients undergoing arthroscopic knee surgery
[2, 10, 16], and approximately 12% in the overall popu-
lation [29]. The clinical impact of these defects, and
therefore the need for clinical intervention, varies as the
presence of defect(s) is not necessarily linked to symptoms.
However, patients commonly present with knee pain,
swelling, locking and catching of the joint, resulting in a
significant loss of function and reduction in quality of life.
Patients with articular cartilage defects are also predis-
posed to developing osteoarthritis with its associated dis-
abilities and socioeconomic impact [11].
Articular cartilage defects may be secondary to sports
injury or other trauma, or primary lesions resulting from
diseases such as osteochondritis dissecans [29]. The avas-
cular nature of articular cartilage means that it has a limited
ability to self-repair and regenerate if damaged. Many
treatment modalities have been employed with the goal of
restoring function and reducing pain. These operative
E. Basad (&) Á B. Ishaque Á H. Stu
¨
rz Á J. Steinmeyer
Clinic and Polyclinic for Orthopaedic Surgery,
University Hospital Giessen-Marburg GmbH,
Paul-Meimberg-Strasse 3, 35392 Giessen, Germany
e-mail: erhan.basad@ortho.med.uni-giessen.de
G. Bachmann
Department of Diagnostic Radiology,
Kerckhoff Clinic, Bad Nauheim, Germany
123
Knee Surg Sports Traumatol Arthrosc (2010) 18:519–527
DOI 10.1007/s00167-009-1028-1