Augmentation techniques have been suggested to remedy the imperfection of microfracture to repair cartilage defects, but the efficacy of the proposed methods is unclear. Collagen-augmented chondrogenesis techniques (C-ACTs) intended to repair cartilage defects is thought to as safe and efficacious than microfracture. The purpose of this study was to examine the quality of articular cartilage repair by C-ACT and its clinical outcomes compared to those achieved by microfracture.
Altogether, 100 participants with knee cartilage defects were randomly assigned to the control group (n = 48, microfracture alone) or the investigational group (n = 52, modified microfracture using C-ACT). Clinical and magnetic resonance imaging (MRI) outcomes were assessed 12 and 24 months postoperatively for efficacy and adverse events. Clinical outcomes were assessed using the visual analogue scale (VAS)–pain, VAS–20% improvement based on minimal clinically important improvement (MCII), Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) score. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) assessment analyzed cartilage tissue repair. MRI outcomes for 50% filling of the defect and the Repair Tissue/Reference Cartilage (RT/RC) ratio were quantified by T2 mapping.
At 24 months postoperatively, the odds ratio (OR) for the VAS–20% improvement rate was significantly higher in the investigational group (OR=2.808, P=0.047). The MOCART score in the investigational group showed improved defect repair and filling (P=0.0201), integration with the border zone (P=0.0062), and effusion (P=0.0079). MRI outcomes showed that the OR for ≥50% defect filling at 12 months was statistically higher in the investigational group (OR=3.984, P=0.0377). The likelihood of the RT/RC OR becoming ≥1 was significantly higher (OR=11.37, P=0.0126) in the investigational group.
This multicenter, randomized trial, both clinically and by imaging, indicated that C-ACT is as effective and safe as microfracture for treating cartilage defects.