Autologous Matrix-Induced Chondrogenesis for Treatment of Focal Cartilage Defects in the Knee: A Follow-up Study.

BACKGROUND: Autologous matrix-induced chondrogenesis (AMIC) is a well-established treatment for full-thickness cartilage defects. PURPOSE: To evaluate the long-term clinical outcomes of AMIC for the treatment of chondral lesions of the knee. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A multisite prospective registry recorded demographic data and outcomes for patients who underwent repair of chondral defects. In total, 131 patients were included in the study. Lysholm, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analog scale (VAS) score for pain were used for outcome analysis. Across all patients, the mean ± SD age of patients was 36.6 ± 11.7 years. The mean body weight was 80.0 ± 16.8 kg, mean height was 176.3 ± 7.9 cm, and mean defect size was 3.3 ± 1.8 cm2. Defects were classified as Outerbridge grade III or IV. A repeated-measures analysis of variance was used to compare outcomes across all time points. RESULTS: The median follow-up time for the patients in this cohort was 4.56 ± 2.92 years. Significant improvement (P < .001) in all scores was observed at 1 to 2 years after AMIC, and improved values were noted up to 7 years postoperatively. Among all patients, the mean preoperative Lysholm score was 46.9 ± 19.6. At the 1-year follow-up, a significantly higher mean Lysholm score was noted, with maintenance of the favorable outcomes at 7-year follow-up. The KOOS also showed a significant improvement of postoperative values compared with preoperative data. The mean VAS had significantly decreased during the 7-year follow-up. Age, sex, and defect size did not have a significant effect on the outcomes. CONCLUSION: AMIC is an effective method of treating chondral defects of the knee and leads to reliably favorable results up to 7 years postoperatively.

Systematic Review and Meta-Analysis of the Clinical Evidence on the Use of Autologous Matrix-Induced Chondrogenesis in the Knee.

OBJECTIVE: A systematic review and meta-analysis of Autologous Matrix-Induced Chondrogenesis (AMIC®) outcomes for grade III/IV chondral and osteochondral lesions of the knee treated with Chondro-Gide®. DESIGN: Studies with a minimum follow-up of 1 year providing clinical results of AMIC repair in the knee were included based on PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Methodological quality was assessed by the modified Coleman Methodology Score (mCMS). The meta-analysis was comparing pain VAS (Visual Analog Scale), Lysholm score, and IKDC score (International Knee Documentation Committee) between baseline and follow-up after 1 or 2 years and after >3 years. RESULTS: Twelve studies (375 patients) were included. The mCMS demonstrated a suboptimal study design (ranking between 52 and 80). The mean age was 36.2 years (14-70 years). The mean defect size was 4.24 cm2 (0.8-22 cm2). The results from the random effects model indicated a clinically significant (P < 0.05) improvement of pain VAS from baseline to follow-up at year 1 to 2 of -4.02(confidence interval -4.37; -3.67), still significant after 3 years. Lysholm score at year 1 or 2 improved significantly and remained highly significant after 3 years. IKDC score showed highly significant improvement of 32.61 between 1 and 2 years versus baseline values maintained after 3 years. CONCLUSIONS: The AMIC procedure significantly improved the clinical status and functional scoring versus preoperative values. Evidence was obtained in a non-selected patient population, corresponding to real-life treatment of knee chondral and osteochondral defects. The evidence is sufficient to recommend AMIC in this indication.

Evaluation of autologous retransfusion from a closed suction drainage system for patient blood management in elective total hip and knee replacement: A two cohort study.

BACKGROUND: Postoperative autologous retransfusion of drainage blood might reduce the transfusion of red blood cell concentrates after major orthopaedic surgery. OBJECTIVES: Our primary objective was to evaluate the effectiveness of a blood collection and retransfusion system. Secondary objectives included safety issues and the quality of the drainage blood collected. DESIGN: Combined retrospective and prospective cohort study. SETTING: Swiss regional hospital, from 1 January to 31 December 2015 (retrospective cohort) and 1 January to 31 August 2018 (prospective cohort). PATIENTS: The retrospective and prospective cohort included 216 and 46 patients, respectively, who underwent elective hip or knee replacement. INTERVENTIONS: Use of a postoperative blood collection and retransfusion system. MAIN OUTCOME MEASURES: The primary outcome was the postoperative haemoglobin in patients with and without autotransfusion. Secondary outcomes were percentage of patients with transfusion of allogeneic blood products and with adverse events with and without autotransfusion. Tertiary outcomes were laboratory levels of specific inflammation and coagulation parameters in collected drain blood directly after surgery and 6 h postoperatively. RESULTS: Autologous retransfusion was performed in 50 patients (23%) in the retrospective analysis. Postoperative haemoglobin level was increased by 5 g dl (P = 0.017) in retransfused patients compared with those without retransfusion. However, there was no difference in the number of transfused allogeneic red blood cell concentrates. Mild adverse transfusion reactions were reported in 13 retransfused patients (26%). Laboratory analyses for the second prospective part detected massively elevated concentrations of myeloperoxidase and IL-6 in the drainage blood, but C-reactive protein and procalcitonin concentrations were within normal ranges at both time points. D-dimers levels were above the upper normal level in 37 and 24% at the two time points, respectively, and tended to decrease over time (P = 0.060). CONCLUSION: Our study questions the effectiveness of postoperative autotransfusion as part of a patient blood management programme. In addition, the obvious signs of inflammatory reactions and coagulation activation raise safety concerns. TRIAL REGISTRATION: The cohort study was not registered in a trial registry.