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. 2015 Apr;6(2):82-97.
doi: 10.1177/1947603514563597.

Matrix-Induced Autologous Chondrocyte Implantation versus Multipotent Stem Cells for the Treatment of Large Patellofemoral Chondral Lesions: A Nonrandomized Prospective Trial

Alberto Gobbi  1 , Sanyam Chaurasia  1 , Georgios Karnatzikos  1 , Norimasa Nakamura  2
Affiliations

Matrix-Induced Autologous Chondrocyte Implantation versus Multipotent Stem Cells for the Treatment of Large Patellofemoral Chondral Lesions: A Nonrandomized Prospective Trial

Alberto Gobbi et al. Cartilage. 2015 Apr.

Abstract

Objective: To compare the outcome of matrix-induced autologous chondrocyte implantation (MACI) and bone marrow aspirate concentrate (BMAC)-derived multipotent stem cells (MSCs) implantation in patellofemoral chondral lesions, using the same HYAFF11 scaffold.

Methods: From January 2005 to December 2010, 37 patients with patellofemoral chondral lesions were prospectively followed up, for a minimum of 3 years; 19 of these patients were treated with MACI and 18 with BMAC. Radiographs, magnetic resonance imaging, and clinical scores (International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, visual analog scale, and Tegner) were collected preoperatively, at 2-year and final follow-up. Five patients of MACI and 6 of the BMAC group underwent second-look arthroscopy; 4 patients of each group consented to a concomitant biopsy.

Results: No adverse reactions or postoperative infections were noted. Baseline characteristics were similar in both groups (P > 0.05). Both groups showed significant improvement in all scores, from preoperative to final follow-up (P = 0.001), but there was no significant difference in improvement between the 2 groups, except for the IKDC subjective score (P = 0.015), which favored the BMAC group. Deterioration in MACI and improvement in BMAC group scores were noticed, from 2-year to final follow-up, but was nonsignificant. MACI patients with trochlear lesions showed better results than patellar lesions, while location was not a prognostic factor in the BMAC group. MRI showed complete filling of the defects in 76% of patients in MACI and 81% of patients in BMAC, and histological analysis revealed hyaline-like features.

Conclusion: Both techniques are viable and effective for large patellofemoral chondral lesions at minimum 3-year follow-up.

Keywords: HYAFF11; bone marrow aspirate concentrate (BMAC); matrix-induced autologous chondrocyte implantation (MACI); multipotent stem cell (MSC); patellofemoral chondral defects.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Anika (Therapeutics, Srl Abano Terme, Italy) has provided a partial grant.

Figures

Figure 1.
Figure 1.
Matrix-induced autologous chondrocyte implantation (MACI) procedure: (A) outlined patellar lesion, (B) prepared bed of lesion in patella, (C) graft templating with cultured chondrocytes, (D) graft implantation.
Figure 2.
Figure 2.
Bone marrow aspirate concentrate (BMAC) implantation: (A) prepared bed of lesion in patella, (B) BMAC clot after activation, (C) clot pasted and scaffold stabilized, (D) fibrin seal.
Figure 3.
Figure 3.
Boxplots describing the mean values of the evaluated scores for both groups: (A) IKDC subjective, (B) KOOS pain, (C) KOOS symptoms, (D) KOOS ADL, (E) KOOS SRA, (F) KOOS QOL, (G) VAS, and (H) Tegner scores. MACI = matrix-induced autologous chondrocyte implantation; BMAC = bone marrow aspirate concentrate; pre-op = preoperative values; pre-inj = preinjury values; IKDC = International Knee Documentation Committee; KOOS = Knee Injury Osteoarthritis Outcome Score; ADL = activities of daily living; SRA = sports and recreational activities; QOL = quality of life; VAS = visual analog scale.
Figure 4.
Figure 4.
Second-look arthroscopy: (A) Trochlear after matrix-induced autologous chondrocyte implantation (MACI) at 29-month follow-up and (B) patellar after bone marrow aspirate concentrate (BMAC) implantation at 24 month follow-up.
Figure 5.
Figure 5.
Histological results showing nearly normal cartilage appearance and dominance of type II collagen: (A) 29 months after matrix-induced autologous chondrocyte implantation (MACI)—case 4 in Table 7 and (B) 24 months after multipotent stem cells (MSCs) implantation—case 2 in Table 7.
Figure 6.
Figure 6.
Magnetic resonance imaging results at 5 years showing good fill on the defect, with no effusion and none or slight bone edema in trochlear regions after (A) matrix-induced autologous chondrocyte implantation (MACI) and (B) bone marrow aspirate concentrate (BMAC) implantation.
See this image and copyright information in PMC

References

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