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Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: early treatment matters

Johan Vanlauwe, Daniel BF Saris, Jan Victor UGent, Karl Almqvist UGent, Johan Bellemans and Frank P Luyten (2011) AMERICAN JOURNAL OF SPORTS MEDICINE. 39(12). p.2566-2574
abstract
Background: Characterized chondrocyte implantation (CCI) results in significantly better early structural tissue regeneration than microfracture (MF), and CCI has a midterm clinical benefit over microfracture. Purpose: This study was undertaken to evaluate the 5-year clinical outcome of CCI in a randomized comparison with MF for the treatment of symptomatic cartilage defects of the femoral condyles of the knee. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Participants aged 18 to 50 years with a symptomatic isolated International Cartilage Repair Society (ICRS) grade III or IV cartilage lesion of the femoral condyles between 1 and 5 cm(2) were randomized to either CCI or MF. Clinical outcomes were measured up to 60 months after surgery using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The main outcome parameter was change from baseline in overall KOOS (oKOOS). Adverse events were monitored. Results: Fifty-one participants were treated with CCI and 61 with MF. On average, clinical benefit was maintained through the 60-month follow-up period. The average change from baseline in oKOOS was not different between both groups (least squares [LS] mean +/- standard error [SE] 18.84 +/- 3.58 for CCI vs 13.21 +/- 5.63 for MF; P = .116). Treatment failures were comparable (n = 7 in CCI vs n = 10 in MF), although MF failures tended to occur earlier. Subgroup analysis revealed that CCI resulted in better outcome in participants with time since symptom onset of less than 3 years, which was statistically significant and clinically relevant (change in oKOOS < 3 years mean +/- SE 25.96 +/- 3.45 for CCI vs 15.28 +/- 3.17 for MF; P = .026 vs oKOOS > 3 years mean +/- SE 13.09 +/- 4.78 for CCI vs 17.02 +/- 4.50 for MF, P = .554). Other subgroup analyses such as age (cutoff 35 years) did not show a difference. Female patients showed more failures irrespective of treatment. Conclusion: At 5 years after treatment, clinical outcomes for CCI and MF were comparable. In the early treatment group, CCI obtained statistically significant and clinically relevant better results than MF. Delayed treatment resulted in less predictable outcomes for CCI. These results provide strong evidence that time since onset of symptoms is an essential variable that should be taken into account in future treatment algorithms for cartilage repair of the knee.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
microfracture, Knee Injury and Osteoarthritis Outcome Score (KOOS), cartilage repair, randomized controlled trial, long term, FREE PERIOSTEAL GRAFTS, LONG-TERM DURABILITY, ARTICULAR-CARTILAGE, RANDOMIZED-TRIAL, OSTEOCHONDRAL DEFECTS, CHONDRAL DEFECTS, FOLLOW-UP, REPAIR, OSTEOARTHRITIS, TRANSPLANTATION, chondrocyte, regenerative medicine, chondral, autologous chondrocyte implantation
journal title
AMERICAN JOURNAL OF SPORTS MEDICINE
Am. J. Sports Med.
volume
39
issue
12
pages
2566 - 2574
Web of Science type
Article
Web of Science id
000297704300006
JCR category
ORTHOPEDICS
JCR impact factor
3.792 (2011)
JCR rank
2/63 (2011)
JCR quartile
1 (2011)
ISSN
0363-5465
DOI
10.1177/0363546511422220
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1978763
handle
http://hdl.handle.net/1854/LU-1978763
date created
2012-01-05 13:32:44
date last changed
2015-06-17 09:53:39
@article{1978763,
  abstract     = {Background: Characterized chondrocyte implantation (CCI) results in significantly better early structural tissue regeneration than microfracture (MF), and CCI has a midterm clinical benefit over microfracture. 
Purpose: This study was undertaken to evaluate the 5-year clinical outcome of CCI in a randomized comparison with MF for the treatment of symptomatic cartilage defects of the femoral condyles of the knee. 
Study Design: Randomized controlled trial; Level of evidence, 1. 
Methods: Participants aged 18 to 50 years with a symptomatic isolated International Cartilage Repair Society (ICRS) grade III or IV cartilage lesion of the femoral condyles between 1 and 5 cm(2) were randomized to either CCI or MF. Clinical outcomes were measured up to 60 months after surgery using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The main outcome parameter was change from baseline in overall KOOS (oKOOS). Adverse events were monitored. 
Results: Fifty-one participants were treated with CCI and 61 with MF. On average, clinical benefit was maintained through the 60-month follow-up period. The average change from baseline in oKOOS was not different between both groups (least squares [LS] mean +/- standard error [SE] 18.84 +/- 3.58 for CCI vs 13.21 +/- 5.63 for MF; P = .116). Treatment failures were comparable (n = 7 in CCI vs n = 10 in MF), although MF failures tended to occur earlier. Subgroup analysis revealed that CCI resulted in better outcome in participants with time since symptom onset of less than 3 years, which was statistically significant and clinically relevant (change in oKOOS {\textlangle} 3 years mean +/- SE 25.96 +/- 3.45 for CCI vs 15.28 +/- 3.17 for MF; P = .026 vs oKOOS {\textrangle} 3 years mean +/- SE 13.09 +/- 4.78 for CCI vs 17.02 +/- 4.50 for MF, P = .554). Other subgroup analyses such as age (cutoff 35 years) did not show a difference. Female patients showed more failures irrespective of treatment. 
Conclusion: At 5 years after treatment, clinical outcomes for CCI and MF were comparable. In the early treatment group, CCI obtained statistically significant and clinically relevant better results than MF. Delayed treatment resulted in less predictable outcomes for CCI. These results provide strong evidence that time since onset of symptoms is an essential variable that should be taken into account in future treatment algorithms for cartilage repair of the knee.},
  author       = {Vanlauwe, Johan and Saris, Daniel BF and Victor, Jan and Almqvist, Karl and Bellemans, Johan and Luyten, Frank P},
  issn         = {0363-5465},
  journal      = {AMERICAN JOURNAL OF SPORTS MEDICINE},
  keyword      = {microfracture,Knee Injury and Osteoarthritis Outcome Score (KOOS),cartilage repair,randomized controlled trial,long term,FREE PERIOSTEAL GRAFTS,LONG-TERM DURABILITY,ARTICULAR-CARTILAGE,RANDOMIZED-TRIAL,OSTEOCHONDRAL DEFECTS,CHONDRAL DEFECTS,FOLLOW-UP,REPAIR,OSTEOARTHRITIS,TRANSPLANTATION,chondrocyte,regenerative medicine,chondral,autologous chondrocyte implantation},
  language     = {eng},
  number       = {12},
  pages        = {2566--2574},
  title        = {Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: early treatment matters},
  url          = {http://dx.doi.org/10.1177/0363546511422220},
  volume       = {39},
  year         = {2011},
}

Chicago
Vanlauwe, Johan, Daniel BF Saris, Jan Victor, Karl Almqvist, Johan Bellemans, and Frank P Luyten. 2011. “Five-year Outcome of Characterized Chondrocyte Implantation Versus Microfracture for Symptomatic Cartilage Defects of the Knee: Early Treatment Matters.” American Journal of Sports Medicine 39 (12): 2566–2574.
APA
Vanlauwe, J., Saris, D. B., Victor, J., Almqvist, K., Bellemans, J., & Luyten, F. P. (2011). Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: early treatment matters. AMERICAN JOURNAL OF SPORTS MEDICINE, 39(12), 2566–2574.
Vancouver
1.
Vanlauwe J, Saris DB, Victor J, Almqvist K, Bellemans J, Luyten FP. Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: early treatment matters. AMERICAN JOURNAL OF SPORTS MEDICINE. 2011;39(12):2566–74.
MLA
Vanlauwe, Johan, Daniel BF Saris, Jan Victor, et al. “Five-year Outcome of Characterized Chondrocyte Implantation Versus Microfracture for Symptomatic Cartilage Defects of the Knee: Early Treatment Matters.” AMERICAN JOURNAL OF SPORTS MEDICINE 39.12 (2011): 2566–2574. Print.