Treatment of large deep osteochondritis lesions of the knee by autologous matrix-induced chondrogenesis (AMIC): Preliminary results in 13 patients - 06/07/18

Doi : 10.1016/j.otsr.2018.05.008

Pierre Bertho ^a, Adrien Pauvert ^b, Thomas Pouderoux ^c, Henri Robert ^b,^⁎
the
Orthopedics, Traumatology Society of Western France (SOO)^d
^a Service d’orthopédie, CHU Pontchaillou, 2, rue Le Guilloux, 35033 Rennes, France
^b Service d’orthopédie, centre hospitalier Nord-Mayenne, 229, boulevard Paul-Lintier, 53100 Mayenne, France
^c Service d’orthopédie, CHU, 4, rue Larrey, 49100 Angers, France
^d Société d’orthopédie de l’ouest (SOO), 18, rue de Bellinière, 49800 Trélazé, France

^⁎Corresponding author.

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Abstract

Background

Osteochondral defects due to advanced osteochondritis of the knee eventually cause osteoarthritis. Autologous matrix-induced chondrogenesis (AMIC) may hold potential for overcoming the treatment challenges raised by defects larger than 2cm². The primary objective of this study was to assess medium-term functional outcomes of AMIC. The secondary objective was to confirm the absence of adverse events.

Hypothesis

AMIC significantly improves knee function in patients with osteochondritis responsible for osteochondral defects grade III or IV in the International Cartilage Repair Society (ICRS) classification.

Material and methods

A total of 13 consecutive patients managed using AMIC between September 2011 and November 2016 were included in a prospective, single-centre, single-surgeon study. There were 8 males and 5 females with a mean age of 29 years (range, 15–51 years). Among them, 9 had had previous surgery. The ICRS grade was IV in 12 patients and III in 1 patient. The defects had a mean surface area of 3.7cm² (range, 2.2–6.9cm²) and mean depth of 0.5mm (range, 0.4–0.8). In each patient, knee function was assessed by an independent examiner based on validated instruments (Knee injury and Osteoarthritis Outcome Score [KOOS], subjective International Knee Documentation Committee [IKDC] score, and visual analogue scale [VAS] pain score).

Results

After a median follow-up of 24 months (range, 12–42 months; minimum, 1 year), 11 patients had significant improvements, with mean increases in the IKDC score and KOOS of 27 and 28 points, respectively. The scores remained stable after the first year. Of the 2 patients with poorer outcomes, 1 had a history of multiple surgical procedures and the other was a 51-year-old female with a defect surface area of 6.9cm². No post-operative complications were recorded.

Conclusion

AMIC is a reliable single-stage method that is both reproducible and widely available. AMIC significantly improves knee function scores in patients with large osteochondral defects due to advanced osteochondritis of the knee.