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Meta-Analysis
. 2021 Dec;13(1_suppl):42S-56S.
doi: 10.1177/1947603519870846. Epub 2019 Sep 11.

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

Matthias R Steinwachs  1 , Justus Gille  2 , Martin Volz  3 , Sven Anders  4 , Roland Jakob  5 , Laura De Girolamo  6 , Piero Volpi  7 , Alfredo Schiavone-Panni  8 , Sven Scheffler  9 , Eric Reiss  10 , Udo Wittmann  11
Affiliations
Meta-Analysis

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

Matthias R Steinwachs et al. Cartilage. 2021 Dec.

Abstract

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.

Keywords: Chondro-Gide®; autologous matrix-induced chondrogenesis (AMIC®); cartilage; knee; microfracture.

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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: MS and RJ are board members from the ON Foundation. None of the authors has a financial interest in the subject matter discussed in the article, although they receive consultancy fees for strategic advice on future developments, by Geistlich Pharma AG.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. Distribution of published clinical papers on the AMIC knee outlining the application of inclusion/exclusion criteria for the meta-analysis.
Figure 2.
Figure 2.
Results from random effects model comparing Visual Analog Scale (VAS) baseline versus year 1 or 2.
Figure 3.
Figure 3.
Results from random effects model comparing Visual Analog Scale (VAS) baseline versus >3 year.
Figure 4.
Figure 4.
Results from random effects model comparing Lysholm baseline versus year 1 or 2.
Figure 5.
Figure 5.
Results from random effects model comparing Lysholm baseline versus >3 years.
Figure 6.
Figure 6.
Results from random effects model comparing International Knee Documentation Committee (IKDC) baseline versus year 1 or 2.
Figure 7.
Figure 7.
Results from random effects model comparing International Knee Documentation Committee (IKDC) baseline versus >3 years.
Figure 8.
Figure 8.
Results from random effects model comparing Visual Analog Scale (VAS) year 1 or 2 versus >3 years.
Figure 9.
Figure 9.
Results from random effects model comparing Lysholm year 1 or 2 versus >3 Years.
Figure 10.
Figure 10.
Results from random effects model comparing International Knee Documentation Committee (IKDC) year 1 or 2 versus >3 years.
Figure 11.
Figure 11.
Steinwachs algorithm 2019: Proposed treatment algorithm for osteochondral lesion on the knee.
See this image and copyright information in PMC

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