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Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

The objective was to evaluate the functional performance over a 2-year period following autologous chondrocyte implantation (ACI) in an open knee procedure compared to microfracture. Objective functional outcome was studied as secondary analysis in a subgroup of patients, in a randomized clinical trial, with concealed allocation and independent evaluators. Sixty-seven patients with local cartilage defect, with a mean size of 2.4 cm² (SD 1.5) of the femoral condyle of the knee were included. Thirty-three patients underwent the microfracture and 34 the ACI procedure. An identical rehabilitation protocol was implemented for both groups. Active knee flexion and extension range, anterior laxity, knee extension strength (concentric at 60°/s) and single leg hop performance (single hop, crossover triple hop and 6 m timed hop test) were evaluated pre-surgery and at 6, 9,12 and 24 months post-surgery. We calculated the symmetry index for individual and four performance tests pooled. Mixed linear model analyses were used with confidence interval set at 95%. The change over 2 years for the pooled performance-based tests was comparable between the two treatment arms. At 2 years, 70% (38/54) of all patients returned to >85% symmetry in overall functional performance. A decrease in functional performance at 6 months following ACI resulted in slower recovery at 9 and 12 months compared to microfracture. Rehabilitation following both cartilage repair procedures is a lengthy process. At 2 years after surgery, ACI patients have similar overall functional outcome compared to microfracture patients.

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Acknowledgments

This work was supported by a grant from the Fund for Scientific Research, Flanders, Belgium. The authors acknowledge and thank Bracing Center (Belgium) and Spronken (the Netherlands) for supplying and adapting the custom-made GII braces for each patient professionally. We also thank Timothy Mutsvari for advice on statistical analysis, the patients and all physiotherapists for their active contributions.

Conflict of interest statement

D.V.A., F.S., D.V.C. declared that they have no conflict of interest. Following co-authors have declared a potential conflict of interest: J.V., reimbursement for study participation, case report form management and educational activities, TiGenix stocks and warrants reimbursement for attending symposia; J.B., TiGenix stocks; D.S., AO International reimbursement for educational activities, Smith & Nephew orthopaedics and Tigenix reimbursement for educational activities and Genzyme reimbursement for study design advice; F.L., cofounder of TiGenix and has a research contract with and stocks of TiGenix.

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Authors and Affiliations

  1. Division of Rheumatology, University Hospitals Leuven, KU Leuven, Herestraat 48, 3000, Leuven, Belgium

    Dieter Van Assche & Frank P. Luyten

  2. Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium

    Filip Staes

  3. Department of Physiotherapy, Central Military Hospital, Utrecht, The Netherlands

    Danny Van Caspel

  4. Department of Orthopedics, University Hospitals Leuven, KU Leuven, Leuven, Belgium

    Johan Vanlauwe & Johan Bellemans

  5. Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands

    Daniel B. Saris

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  1. Dieter Van Assche
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  2. Filip Staes
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Correspondence to Dieter Van Assche.

Electronic supplementary material

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167_2009_955_MOESM1_ESM.doc

Electronic Addendum: Study Procedure, Rehabilitation Protocol and Assessments. Study Procedure and Rehabilitation protocol. Supplementary material 1 (DOC 444 kb)

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Van Assche, D., Staes, F., Van Caspel, D. et al. Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 18, 486–495 (2010). https://doi.org/10.1007/s00167-009-0955-1

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  • DOI: https://doi.org/10.1007/s00167-009-0955-1

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