Arthroscopic Treatment of Patellar and Trochlear Cartilage Lesions with Matrix Encapsulated Chondrocyte Implantation versus Microfracture: Quantitative Assessment with MRI T2-Mapping and MOCART at 4-Year Follow-up

Abstract

Methods Seventeen patients aged 18 to 55 years with symptomatic full-thickness cartilage lesions on either patella or trochlea were treated with matrix autologous chondrocyte implantation (MACI) or microfracture (MF). Both procedures combined with unloading/realigning techniques. Clinical assessment and T2-mapping were evaluated at 48-months. Results Clinically results from pre-op to 48-months improved significantly in MACI and MF for Lysholm ( p = 0.001, p = 0.001), IKDC-S ( p = 0.001, p = 0.002), KOOS-P ( p = 0.000, p = 0.002), KOOS-DLA ( p = 0.002, p = 0.003), KOOS-Sports/Rec ( p = 0.000, p = 0.004), KOOS-QoL ( p = 0.000, p = 0.003), KOOS-symptoms ( p = 0.001, p = 0.020), and Kujala ( p = 0.000, p = 0.01), respectively. Tegner was significant between baseline and 48 months only for MACI ( p < 0.008) compared with MF ( p = 0.25). No significant difference was observed between groups for any score at 3, 12, 24, and 48-months ( p > 0.05). T2-mapping values improved significantly over time in MACI compared with MF at 24 months (39.35 vs. 50.44, p = 0.007) and 48 months (36.54 vs. 48.37, p = 0.005). When comparing control values to MACI at 12-m ( p = 0.714), 24-m ( p = 0.175), and 48-m ( p = 0.097), no significant difference was found. MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score comparison gave no statistical difference between groups. Conclusions Clinically both techniques improved significantly over time. However, quantitative assessment showed that only newly formed tissue with MACI technique improves significantly since 12-months and maintains stable values compared with native cartilage until 48-month follow-up. MF results were never comparable to those native values. Level of evidence II.