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Published in: Journal of Orthopaedic Science 1/2013

01-01-2013 | Original Article

CaReS® (MACT) versus microfracture in treating symptomatic patellofemoral cartilage defects: a retrospective matched-pair analysis

Authors: Maximilian Petri, Maximilian Broese, Annika Simon, Emmanouil Liodakis, Max Ettinger, Daniel Guenther, Johannes Zeichen, Christian Krettek, Michael Jagodzinski, Carl Haasper

Published in: Journal of Orthopaedic Science | Issue 1/2013

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Abstract

Background

Treating patellofemoral articular cartilage lesions remains a challenging task in orthopedic surgery. Whereas microfracture and autologous chondrocyte implantation yield good results on femoral condyles, the therapeutic state of the art for treating patellofemoral lesions is yet to be determined. In this study, we compared the CaReS® technique, which is a matrix-associated autologous chondrocyte implantation technique, to microfracture for treating patellofemoral articular cartilage lesions.

Methods

Between May 2003 and December 2005, 17 patients with an isolated patellofemoral cartilage defect (International Cartilage Repair Society III/IV) were treated with the CaReS® technique at our department. After adjusting for inclusion and exclusion criteria, ten of these patients could be included in this study; ten patients treated with microfracture were chosen as a matched-pair group. Clinical outcome was evaluated 3 years after surgery by the 36-item Short Form Health Survey Questionnaire (SF-36), International Knee Documentation Committee (IKDC) subjective evaluation of the knee, Lysholm Score, and Cincinnati Modified Rating Scale scores.

Results

Patients treated with CaReS® had statistically significantly improved IKDC, Lysholm, and Cincinnati scores 36 months after surgery compared with preoperatively. When comparing outcome between groups 36 months after surgery, there was no statistically difference in IKDC, Lysholm, and Cincinnati scores.

Conclusions

This is the first trial comparing the CaReS® technique and microfracture for treating patellofemoral articular cartilage lesions, and results show that CaReS® yields comparable results to microfracture. The small number of patients is a limiting factor of the study, leading to results without statistical significance. A multicentric prospective randomized study comparing the two procedures is desirable.
Literature
2.
go back to reference Steinwachs MR, Guggi T, Kreuz PC. Marrow stimulation techniques. Injury. 2008;39(Suppl 1):S26–31.PubMedCrossRef Steinwachs MR, Guggi T, Kreuz PC. Marrow stimulation techniques. Injury. 2008;39(Suppl 1):S26–31.PubMedCrossRef
3.
go back to reference Basad E, Ishaque B, Bachmann G, Sturz H, Steinmeyer J. Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study. Knee Surg Sports Traumatol Arthrosc. 2010;18:519–27.PubMedCrossRef Basad E, Ishaque B, Bachmann G, Sturz H, Steinmeyer J. Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study. Knee Surg Sports Traumatol Arthrosc. 2010;18:519–27.PubMedCrossRef
4.
go back to reference Gobbi A, Kon E, Berruto M, Filardo G, Delcogliano M, Boldrini L, Bathan L, Marcacci M. Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: results at 5 years’ follow-up. Am J Sports Med. 2009;37:1083–92.PubMedCrossRef Gobbi A, Kon E, Berruto M, Filardo G, Delcogliano M, Boldrini L, Bathan L, Marcacci M. Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: results at 5 years’ follow-up. Am J Sports Med. 2009;37:1083–92.PubMedCrossRef
5.
go back to reference Zeifang F, Oberle D, Nierhoff C, Richter W, Moradi B, Schmitt H. Autologous chondrocyte implantation using the original periosteum-cover technique versus matrix-associated autologous chondrocyte implantation: a randomized clinical trial. Am J Sports Med. 2010;38:924–33.PubMedCrossRef Zeifang F, Oberle D, Nierhoff C, Richter W, Moradi B, Schmitt H. Autologous chondrocyte implantation using the original periosteum-cover technique versus matrix-associated autologous chondrocyte implantation: a randomized clinical trial. Am J Sports Med. 2010;38:924–33.PubMedCrossRef
6.
go back to reference Harris JD, Siston RA, Pan X, Flanigan DC. Autologous chondrocyte implantation: a systematic review. J Bone Joint Surg Am. 2010;92:2220–33.PubMedCrossRef Harris JD, Siston RA, Pan X, Flanigan DC. Autologous chondrocyte implantation: a systematic review. J Bone Joint Surg Am. 2010;92:2220–33.PubMedCrossRef
7.
go back to reference Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grontvedt T, Solheim E, Strand T, Roberts S, Isaksen V, Johansen O. Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am. 2004;86-A:455–64.PubMed Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grontvedt T, Solheim E, Strand T, Roberts S, Isaksen V, Johansen O. Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am. 2004;86-A:455–64.PubMed
8.
go back to reference Saris DB, Vanlauwe J, Victor J, Almqvist KF, Verdonk R, Bellemans J, Luyten FP. Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med. 2009;37(Suppl 1):10S–9S.PubMedCrossRef Saris DB, Vanlauwe J, Victor J, Almqvist KF, Verdonk R, Bellemans J, Luyten FP. Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med. 2009;37(Suppl 1):10S–9S.PubMedCrossRef
9.
go back to reference Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O. A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am. 2007;89:2105–12.PubMedCrossRef Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O. A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am. 2007;89:2105–12.PubMedCrossRef
10.
go back to reference Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M. Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med. 2009;37:33–41.PubMedCrossRef Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M. Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med. 2009;37:33–41.PubMedCrossRef
11.
go back to reference Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M, Sudkamp N. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage. 2006;14:1119–25.PubMedCrossRef Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M, Sudkamp N. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage. 2006;14:1119–25.PubMedCrossRef
12.
go back to reference Niemeyer P, Steinwachs M, Erggelet C, Kreuz PC, Kraft N, Kostler W, Mehlhorn A, Sudkamp NP. Autologous chondrocyte implantation for the treatment of retropatellar cartilage defects: clinical results referred to defect localisation. Arch Orthop Trauma Surg. 2008;128:1223–31.PubMedCrossRef Niemeyer P, Steinwachs M, Erggelet C, Kreuz PC, Kraft N, Kostler W, Mehlhorn A, Sudkamp NP. Autologous chondrocyte implantation for the treatment of retropatellar cartilage defects: clinical results referred to defect localisation. Arch Orthop Trauma Surg. 2008;128:1223–31.PubMedCrossRef
13.
go back to reference Mithoefer K, Williams RJ 3rd, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am. 2005;87:1911–20.PubMedCrossRef Mithoefer K, Williams RJ 3rd, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am. 2005;87:1911–20.PubMedCrossRef
14.
go back to reference Pascual-Garrido C, Slabaugh MA, L’Heureux DR, Friel NA, Cole BJ. Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: prospective evaluation at average 4-year follow-up. Am J Sports Med. 2009;37(Suppl 1):33S–41S.PubMedCrossRef Pascual-Garrido C, Slabaugh MA, L’Heureux DR, Friel NA, Cole BJ. Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: prospective evaluation at average 4-year follow-up. Am J Sports Med. 2009;37(Suppl 1):33S–41S.PubMedCrossRef
15.
go back to reference Minas T, Bryant T. The role of autologous chondrocyte implantation in the patellofemoral joint. Clin Orthop Relat Res. 2005;436:30–9.PubMedCrossRef Minas T, Bryant T. The role of autologous chondrocyte implantation in the patellofemoral joint. Clin Orthop Relat Res. 2005;436:30–9.PubMedCrossRef
16.
go back to reference Gobbi A, Kon E, Berruto M, Francisco R, Filardo G, Marcacci M. Patellofemoral full-thickness chondral defects treated with Hyalograft-C: a clinical, arthroscopic, and histologic review. Am J Sports Med. 2006;34:1763–73.PubMedCrossRef Gobbi A, Kon E, Berruto M, Francisco R, Filardo G, Marcacci M. Patellofemoral full-thickness chondral defects treated with Hyalograft-C: a clinical, arthroscopic, and histologic review. Am J Sports Med. 2006;34:1763–73.PubMedCrossRef
17.
go back to reference Peterson L, Vasiliadis HS, Brittberg M, Lindahl A. Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med. 2010;38:1117–24.PubMedCrossRef Peterson L, Vasiliadis HS, Brittberg M, Lindahl A. Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med. 2010;38:1117–24.PubMedCrossRef
18.
go back to reference Moseley JB Jr, Anderson AF, Browne JE, Mandelbaum BR, Micheli LJ, Fu F, Erggelet C. Long-term durability of autologous chondrocyte implantation: a multicenter, observational study in US patients. Am J Sports Med. 2010;38:238–46.PubMedCrossRef Moseley JB Jr, Anderson AF, Browne JE, Mandelbaum BR, Micheli LJ, Fu F, Erggelet C. Long-term durability of autologous chondrocyte implantation: a multicenter, observational study in US patients. Am J Sports Med. 2010;38:238–46.PubMedCrossRef
19.
go back to reference Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003;19:477–84.PubMedCrossRef Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003;19:477–84.PubMedCrossRef
20.
go back to reference Andereya S, Maus U, Gavenis K, Gravius S, Stanzel S, Muller-Rath R, Miltner O, Mumme T, Schneider U. Treatment of patellofemoral cartilage defects utilizing a 3D collagen gel: two-year clinical results. Z Orthop Unfall. 2007;145:139–45.PubMedCrossRef Andereya S, Maus U, Gavenis K, Gravius S, Stanzel S, Muller-Rath R, Miltner O, Mumme T, Schneider U. Treatment of patellofemoral cartilage defects utilizing a 3D collagen gel: two-year clinical results. Z Orthop Unfall. 2007;145:139–45.PubMedCrossRef
21.
go back to reference Schneider U, Rackwitz L, Andereya S, Siebenlist S, Fensky F, Reichert J, Loer I, Barthel T, Rudert M, Noth U. A prospective multicenter study on the outcome of type I collagen hydrogel-based autologous chondrocyte implantation (CaReS) for the repair of articular cartilage defects in the knee. Am J Sports Med. 2011;39:2558–65.PubMedCrossRef Schneider U, Rackwitz L, Andereya S, Siebenlist S, Fensky F, Reichert J, Loer I, Barthel T, Rudert M, Noth U. A prospective multicenter study on the outcome of type I collagen hydrogel-based autologous chondrocyte implantation (CaReS) for the repair of articular cartilage defects in the knee. Am J Sports Med. 2011;39:2558–65.PubMedCrossRef
22.
go back to reference Behrens P, Bosch U, Bruns J, Erggelet C, Esenwein SA, Gaissmaier C, Krackhardt T, Lohnert J, Marlovits S, Meenen NM, Mollenhauer J, Nehrer S, Niethard FU, Noth U, Perka C, Richter W, Schafer D, Schneider U, Steinwachs M, Weise K. Indications and implementation of recommendations of the working group “Tissue Regeneration and Tissue Substitutes” for autologous chondrocyte transplantation (ACT). Z Orthop Ihre Grenzgeb. 2004;142:529–39.PubMedCrossRef Behrens P, Bosch U, Bruns J, Erggelet C, Esenwein SA, Gaissmaier C, Krackhardt T, Lohnert J, Marlovits S, Meenen NM, Mollenhauer J, Nehrer S, Niethard FU, Noth U, Perka C, Richter W, Schafer D, Schneider U, Steinwachs M, Weise K. Indications and implementation of recommendations of the working group “Tissue Regeneration and Tissue Substitutes” for autologous chondrocyte transplantation (ACT). Z Orthop Ihre Grenzgeb. 2004;142:529–39.PubMedCrossRef
23.
go back to reference Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001;391:S362–9.PubMedCrossRef Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001;391:S362–9.PubMedCrossRef
24.
go back to reference Gomoll AH, Farr J, Gillogly SD, Kercher J, Minas T. Surgical management of articular cartilage defects of the knee. J Bone Joint Surg Am. 2010;92:2470–90.PubMed Gomoll AH, Farr J, Gillogly SD, Kercher J, Minas T. Surgical management of articular cartilage defects of the knee. J Bone Joint Surg Am. 2010;92:2470–90.PubMed
25.
go back to reference Brittberg M. Cell carriers as the next generation of cell therapy for cartilage repair: a review of the matrix-induced autologous chondrocyte implantation procedure. Am J Sports Med. 2010;38:1259–71.PubMedCrossRef Brittberg M. Cell carriers as the next generation of cell therapy for cartilage repair: a review of the matrix-induced autologous chondrocyte implantation procedure. Am J Sports Med. 2010;38:1259–71.PubMedCrossRef
26.
go back to reference Harris JD, Brophy RH, Siston RA, Flanigan DC. Treatment of chondral defects in the athlete’s knee. Arthroscopy. 2010;26:841–52.PubMedCrossRef Harris JD, Brophy RH, Siston RA, Flanigan DC. Treatment of chondral defects in the athlete’s knee. Arthroscopy. 2010;26:841–52.PubMedCrossRef
27.
go back to reference Jakobsen RB, Engebretsen L, Slauterbeck JR. An analysis of the quality of cartilage repair studies. J Bone Joint Surg Am. 2005;87:2232–9.PubMedCrossRef Jakobsen RB, Engebretsen L, Slauterbeck JR. An analysis of the quality of cartilage repair studies. J Bone Joint Surg Am. 2005;87:2232–9.PubMedCrossRef
28.
go back to reference Brittberg M, Tallheden T, Sjogren-Jansson B, Lindahl A, Peterson L. Autologous chondrocytes used for articular cartilage repair: an update. Clin Orthop Relat Res. 2001;391:S337–48.PubMedCrossRef Brittberg M, Tallheden T, Sjogren-Jansson B, Lindahl A, Peterson L. Autologous chondrocytes used for articular cartilage repair: an update. Clin Orthop Relat Res. 2001;391:S337–48.PubMedCrossRef
29.
go back to reference Bentley G, Biant LC, Carrington RW, Akmal M, Goldberg A, Williams AM, Skinner JA, Pringle J. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. 2003;85:223–30.PubMedCrossRef Bentley G, Biant LC, Carrington RW, Akmal M, Goldberg A, Williams AM, Skinner JA, Pringle J. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. 2003;85:223–30.PubMedCrossRef
30.
go back to reference Farr J. Autologous chondrocyte implantation improves patellofemoral cartilage treatment outcomes. Clin Orthop Relat Res. 2007;463:187–94.PubMed Farr J. Autologous chondrocyte implantation improves patellofemoral cartilage treatment outcomes. Clin Orthop Relat Res. 2007;463:187–94.PubMed
31.
go back to reference Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med. 2009;37:2053–63.PubMedCrossRef Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med. 2009;37:2053–63.PubMedCrossRef
32.
go back to reference Saris DB, Vanlauwe J, Victor J, Haspl M, Bohnsack M, Fortems Y, Vandekerckhove B, Almqvist KF, Claes T, Handelberg F, Lagae K, van der Bauwhede J, Vandenneucker H, Yang KG, Jelic M, Verdonk R, Veulemans N, Bellemans J, Luyten FP. Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med. 2008;36:235–46.PubMedCrossRef Saris DB, Vanlauwe J, Victor J, Haspl M, Bohnsack M, Fortems Y, Vandekerckhove B, Almqvist KF, Claes T, Handelberg F, Lagae K, van der Bauwhede J, Vandenneucker H, Yang KG, Jelic M, Verdonk R, Veulemans N, Bellemans J, Luyten FP. Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med. 2008;36:235–46.PubMedCrossRef
33.
go back to reference Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T. Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med. 2009;37:902–8.PubMedCrossRef Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T. Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med. 2009;37:902–8.PubMedCrossRef
Metadata
Title
CaReS® (MACT) versus microfracture in treating symptomatic patellofemoral cartilage defects: a retrospective matched-pair analysis
Authors
Maximilian Petri
Maximilian Broese
Annika Simon
Emmanouil Liodakis
Max Ettinger
Daniel Guenther
Johannes Zeichen
Christian Krettek
Michael Jagodzinski
Carl Haasper
Publication date
01-01-2013
Publisher
Springer Japan
Published in
Journal of Orthopaedic Science / Issue 1/2013
Print ISSN: 0949-2658
Electronic ISSN: 1436-2023
DOI
https://doi.org/10.1007/s00776-012-0305-x

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