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. 2021 Nov;29(11):3664-3677.
doi: 10.1007/s00167-020-06339-0. Epub 2020 Dec 3.

Typical MRI-pattern suggests peak maturation of the ACI graft 2 years after third-generation ACI: a systematic review

Edna Iordache  1 , Emma L Robertson  1 , Anna Hirschmann  2   3 , Michael T Hirschmann  4   5
Affiliations

Typical MRI-pattern suggests peak maturation of the ACI graft 2 years after third-generation ACI: a systematic review

Edna Iordache et al. Knee Surg Sports Traumatol Arthrosc. 2021 Nov.

Abstract

Purpose: The purpose of the present article was (1) to systematically review the current literature and (2) to collect data regarding the postoperative magnetic resonance imaging (MRI) appearance of third-generation autologous chondrocyte implantation (ACI) grafts and (3) to provide an overview of imaging findings at various postoperative time points.

Methods: A systematic review of the literature in Medline (Pubmed) and Embase was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles which reported the post-operative MRI morphological outcomes following the use of third-generation ACI for treatment of knee cartilage lesions were included. All MRI results were allocated to six different time intervals: ≤ 3 months, > 3-6 months, > 6 months-1 year, > 1 year-2 years, > 2-5 years and > 5 years after surgery.

Results: A total of 22 studies were included and the study populations ranged from 13 to 180 patients adding up to a total of 951 patients. Parameters such as defect fill, border integration, surface contour, graft morphology and integrity of the subchondral lamina all improve gradually with a peak two years following surgery suggesting complete graft maturation at this time point. After this peak, a statistically insignificant decline is noted for most of the parameters. Signal intensity was found to gradually shift from hyperintense to isointense in the first 36 months and to hypointense later on. Contrarily, subchondral bone edema is not only a postoperative feature of the procedure but also can reappear or persist up to ten years after surgery. As graft failures can appear after two years, consequently, the MRI composite score is also affected.

Conclusion: Recurring patterns in postoperative MRI appearance were observed in certain parameters including defect filling, graft signal intensity and structure, border integration of the graft while parameters like subchondral bone tend to be unpredictable. Given the heterogenous findings in terms of clinical correlation, and relating that aspect to the patterns found in this review, an MRI is justified at three months, one year, two years and five years after surgery, unless the clinical symptomatology and individual patient needs dictate otherwise.

Level of evidence: IV.

Keywords: ACI; Autologous cartilage transplantation; Cartilage; Knee; MACI; Magnetic resonance imaging; Transplantation.

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References

    1. Aldrian S, Zak L, Wondrasch B, Albrecht C, Stelzeneder B, Binder H et al (2014) Clinical and radiological long-term outcomes after matrix-induced autologous chondrocyte transplantation: a prospective follow-up at a minimum of 10 years. Am J Sports Med 42(11):2680–2688 - DOI
    1. Anderson DE, Williams RJ, DeBerardino TM, Taylor DC, Benjamin C, Kane MS (2017) Magnetic resonance imaging characterization and clinical outcomes after NeoCart surgical therapy as a primary reparative treatment for knee cartilage injuries. Am J Sports Med 45(4):875–883 - DOI
    1. Blackman AJ, Smith MV, Flanigan DC, Mataya MJ, Wright RW, Brophy RH (2013) Correlation between magnetic resonance imaging and clinical outcomes after cartilage repair surgery in the knee a systematic review and meta-analysis. Am J Sports Med 41(6):1426–1434 - DOI
    1. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331(14):889–895 - DOI
    1. Crema MD, Roemer FW, Marra MD, Burstein D, Gold GE, Eckstein F et al (2011) Articular cartilage in the knee: current MR imaging techniques and applications in clinical practice and research. Radiographics 31(1):37–61 - DOI

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