Purpose
To systematically review randomized controlled trials to compare clinical outcomes
of microfracture (MFx) versus third-generation autologous chondrocyte implantation
(ACI) for the treatment of focal chondral defects (FCDs) of the knee joint.
Methods
A systematic review was performed by searching PubMed, Cochrane Library, and EMBASE
to locate randomized controlled trials comparing minimum 2-year clinical outcomes
of patients undergoing MFx versus third-generation ACI for FCDs of the knee joint.
The search terms used were: “knee” AND “microfracture” AND “autologous chondrocyte”
AND “randomized.” Patients were evaluated based on treatment failure rates, magnetic
resonance imaging, International Cartilage Repair Society scores, and patient-reported
outcome scores (Lysholm, Tegner, Knee Injury and Osteoarthritis Outcome Score, modified
Cincinnati Knee Rating System, 12-item Short Form Health Survey Physical and Mental,
and the EuroQol 5 Dimensions Visual Analog Scale score).
Results
Six studies (5 Level I, 1 Level II) met inclusion criteria, including a total of 238
patients undergoing MFx and 274 undergoing ACI. Two studies had an overlapping cohort
of patients and therefore the study with longer follow-up was used in all analyses.
The average follow-up among patients ranged from 2.0 years to 6.0 years. Average lesion
size ranged from 1.8 cm2 to 5.0 cm2. Treatment failure ranged from 0% to 1.8% in the ACI group and 2.5% to 8.3% in the
MFx group. In 4 studies, ACI patients demonstrated significantly greater improvement
in multiple Knee Injury and Osteoarthritis Outcome Score subscores compared with MFx.
In 2 studies, patients who received ACI demonstrated significantly greater improvement
in the Tegner score compared to MFx, and 1 study showed significantly greater improvement
in the Lysholm and ICRS scores for ACI compared with MFx.
Conclusions
At short-term follow-up, third-generation ACI demonstrates a lower failure rate and
greater improvement in patient-reported outcomes compared with MFx for FCDs of the
knee joint.
Level of Evidence
II, systematic review of Levels I-II studies.
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Article Info
Publication History
Published online: March 09, 2022
Accepted:
February 6,
2022
Received:
October 23,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
P.C.M. reports consultant for Arthrex and research support from Smith & Nephew, outside the submitted work. A.J.S. reports consultant for Mitek; stock/stock options from Biomet , CONMED Linvatec, Johnson & Johnson , Pfizer , Smith & Nephew, and Stryker; and research support from Isto Biologics, outside the submitted work. ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
