Table 1.
Characteristics of the 23 Articles Included in the Qualitative Data Synthesis, with Study Quality Assessment.
| Author(s) | Type of Study | No. of Initial Patients/Patients at Follow-up | Age Sex BMI |
Follow-up | Size Location Classification |
Type of Treatment | Results | Coleman Methodology Score |
|---|---|---|---|---|---|---|---|---|
| Benthien et al. AOB 2010 |
Retrospective case series | 3/3 | — | 18 months | — | MFX and glued AMIC (Chondro-Gide) | Improvement of the Oxford Knee Score after 18 months in 3 patients with retropatellar osteochondral defects treated | 32 |
| Gille et al. KSSTA 2010 |
Prospective case series | 27/24 | 39 years (16-50 years) 16 M/11 F 26 (30-32) |
37 months | 4.2 cm2 (range 1.3-8.8) 7 MFC/3 LFC/2 Tro/9 Pat/6 Pat + CF 100% IV |
MFX and glued AMIC (Chondro-Gide) | Significant improvement (P < 0.05) of all scores was observed as early as 12 months after AMIC, and further increased values were notable up to 24 months postoperatively | 59 |
| Pascarella et al. KSSTA 2010 |
Prospective case series | 19/19 | 26 years (18-50 years) 12 M/7 F — |
24 months | 3.6 cm2 (2.8-3.9) 12 MFC/5 LFC/2 Pat III: 12 – IV: 7 |
MFX and modified AMIC technique (Chondro-Gide) | Good to excellent outcome for the majority of the patients at 24 months postoperatively | 56 |
| Schiavone Panni et al. IJIP 2011 |
Prospective case series | 17/17 | 39 years (22-52 years) 6 M/9 F 28 (23-33) |
36 moths | 4.6 cm2 (2.5-8.0) 8 MFC/3 LFC/5 Tro/1 Pat — |
Modified AMIC (Chondro-Gide) | At an average follow-up of 36 months, mean IKDC score and Lysholm score improved in all patients | 61 |
| Efe et al. KSSTA 2012 |
Prospective case series | 15/15 | 26 ± 8 years 6 M/9 F — |
24 months | <11 mm (diameter) 8 MFC/3 LFC/4 Pat III-IV |
Debridement + press-fit with autologous cancellous bone from, then cell-free collagen type I gel (CaReS-1S) | Cell-free collagen type I matrix repair of small articular cartilage lesions in the knee leads to good clinical results at a follow-up of 2 years | 58 |
| Kusano et al. KSSTA 2012 |
Retrospective comparative study | 11/11 | 26 ± 3 years 5 M/6 F 26 ± 2 |
27 months | 4.2 ± 0.4 cm2
11 MFC III-IV |
MFX and sutured and glued AMIC (Chondro-Gide) | Significant improvements in clinical outcome scores were noted in the 3 groups at a follow-up of 28 months. The largest improvements were seen in the osteochondral subgroup. | 50 |
| 20/20 | 39 ± 3 years 10 M/10 F 25 ± 1 |
29 months | 4.4 ± 0.6 cm2
20 Pat III-IV |
MFX and sutured and glued AMIC (Chondro-Gide) | ||||
| 9 / 9 | 39 Y ± 4 8M/1F 26 ± 1 |
30 m | 2.3 cm2 ± 0.4 5 MFC / 4 LFC III - IV |
MFX and Sutured & glued AMIC (Chondro-Gide) | ||||
| Anders et al. OOJ 2013 |
Randomized controlled trial | 13/8 | 33 years 11 M/2 F 28 |
24 months | 3.7 cm2
— III: 7 - IV: 6 |
MFX and sutured AMIC (Chondro-Gide) | This study confirms the effectiveness and safety of AMIC glued or sutured and demonstrates that the good results observed at 1-year post-operation are maintained at 2-years. | 62 |
| 15/13 | 38 years 12 M /3 F 28 |
24 months | 3.5 cm2
— III: 6 - IV: 9 |
MFX and glued AMIC (Chondro-Gide) | ||||
| Gille et al. AOTS 2013 |
Retrospective case series | 57/57 | 37 years (1761) 38 M/19 F — |
24 months | 3.4 cm2 (1.0-12.0) 32 MFC/6 LFC/4 Tro/15 Pat III: 20 - IV: 37 |
MFX and AMIC (Chondro-Gide) | The majority of patients were satisfied with the postoperative outcome, reporting a gradual and significant clinical improvement at follow-ups 1 and 2 years after surgery | 51 |
| Shetty et al. Orthopedics 2013 |
Retrospective case series | 10/10 | 45 ± 11 years — — |
24 months | 2-8 cm2
— III-IV |
Microdrilling, Autologous collagen-induced chondrogenesis (ACIC): Arthroscopically injection of 1 mL of fibrinogen (Tisseel) and 0.9 mL of atelocollagen (CartiFill) and 0.1 mL of thrombin under CO2 insufflation | A single-stage arthroscopic procedure using microdrilling combined with ACIC appears to be an effective cartilage regeneration method | 48 |
| Dhollander et al. AOB 2014 |
Prospective case series | 10/10 | 37 ± 7 years 8 M/2 F — |
24 months | 4.2 ± 1.9 cm2
8 Pat/2 Tro III-IV |
MFX and sutured AMIC (Chondro-Gide) | The patients included in this study showed a significant gradual clinical improvement after the osteochondral scaffold plug. However, this clinical improvement was not confirmed by the MRI findings | 58 |
| Schuttler et al. KSSTA 2014 |
Prospective case series | 15/15 | 24 years 6 M/9 F 25 ± 5 |
48 months | 0.82 ± 0.19 cm2
MFC 8/LFC 3/Pat 4 III-IV |
Debridement, defect filled with autologous cancellous bone, then implanted cell-free collagen type I gel matrix (CaReS-1S) | This study showed that the use of cell-free collagen type I matrix implants led to a significant and durable improvement in all the clinical and imaging scores investigated 4 years after implantation | 61 |
| Roessler et al. IntOrth 2015 |
Prospective case series | 28/28 | 35 years 17 M/11 F — |
24 months | 3.71 ± 1.93 cm2
MFC 18/LFC 3/Pat 7 — |
Debridement and cell-free collagen type I gel matrix (CaReS-1S) | Cell-free collagen type I matrices appear to be a safe and suitable treatment option even for large cartilage defects of the knee. Results of this study were comparable to the better-established findings for small cartilage defects | 62 |
| Shetty et al. JCOT 2016 |
Prospective case series | 30/30 | 18-65 years — — |
48 months | 2-8 cm2
— III-IV |
Microdrilling, autologous collagen-induced chondrogenesis (ACIC): Arthroscopically injection of 1 mL of fibrinogen (Tisseel) and 0.9 mL of atelocollagen (Coltrix) and 0.1 mL of thrombin under CO2 insufflation | A single-stage arthroscopic procedure using microdrilling combined with atelocollagen and fibrin gel appears to be an effective cartilage regeneration method | 65 |
| Sofu et al. Arthroscopy 2017 |
Retrospective comparative study | 19/19 | 40 ± 10 years 9 M/19 F 23 ± 2 |
24 months | 3.6 ± 1.3 cm2
13 MFC/6 LFC III-IV |
Debridement, MFX + hyaluronic acid-based cell-free scaffold (Hyalofast) | Single-stage regenerative cartilage surgery using hyaluronic acid–based cell free scaffold in combination with MFX revealed promising clinical outcomes at 24 months of follow-up, but the clinical significance of the differences seen is simply not known. | 51 |
| Sadlik et al. JKS 2017 |
Prospective case series | 12/12 | 36 years (22-52) 7 M/5 F — |
38 months | 2.4 cm2 (0.8-4.0) 12 Pat III: 7 - IV: 5 |
Debridement and AMIC-aided: Collagen matrix (Chondro-Gide) fixated with fibrin glue | Significantly improved clinical and radiological results after all-arthroscopic AMIC repair of patellar lesions | 61 |
| Volz et al. IntOrth 2017 |
Randomized controlled trial | 17/16 | 34 ± 11 years 12 M/5 F 27 ± 4 |
60 months | 3.8 ± 2.1 cm2
— — |
MFX and sutured AMIC (Chondro-Gide) | AMIC is an effective cartilage repair procedure in the knee resulting in stable clinical results significantly better than the MFx group at 5 years | 73 |
| 17/14 | 39 ± 9 years 15 M/2 F 27 ± 4 |
60 months | 3.9 ± 1.1 cm2
— — |
MFX and glued AMIC (Chondro-Gide) | ||||
| Schagemann et al. AOTS 2018 |
Retrospective comparative study | 20/20 | 38 years (18-70) 13 M/7 F 27 (19-35) |
24 months | 3.1 cm2(1.0-6.0) 10 MFC/2 LFC/2 Tro/6 Pat III-IV |
MFX and arthroscopic glued AMIC (Chondro-Gide) | Our results suggest that mini-open AMIC is equivalent to the arthroscopic procedure at a follow-up of 1 and 2 years | 36 |
| 30/30 | 34 years (14-53) 17 M/13 F 24 (18-29) |
24 months | 3.4 cm2 (1.5-12.0) 13 MFC/6 LFC/1 Tro/9 Pat/1 TP III-IV |
Mini-open glued AMIC (Chondro-Gide) | ||||
| Bertho et al. OTSR 2018 |
Prospective case series |
13 / 13 | 29 Y (15-51) 8M/5F - |
24 m | 3.7 cm² (2.2 - 6.6) 8 MFC / 4 LFC / 1 Pat III: 1 - IV: 12 |
Drilling, AMIC sutured (Chondro-Gide) | AMIC significantly improves knee function scores in patients with large osteochondral defects due to advanced osteochondritis of the knee | 46 |
| Hoburg et al. AOTS 2018 |
Prospective case series | 15/15 | 26 years (17-41) 9 M/6 F 25 (21-35) |
49 months | 4.98 ± 3.02 cm2
15 MFC III: 11 - IV: 4 |
Debridement, drilling, bone grafting + Chondro-Gide | Significant improvement of knee function could be achieved with simultaneous AMIC procedure and bone grafting in 2/3 of patients with large osteochondral lesions at 4 years | 59 |
| Lahner et al. BMRI 2018 |
Prospective case series | 9/9 | 45 ± 10 years — 29 |
15 months | 2.1 ± 1.2 cm2
— III-IV |
MFX and glued AMIC (Chondro-Gide) | The AMIC procedure enhances pain reduction and gain of knee function for cartilage defects of overweight patients | 55 |
| Schiavone Panni et al. KSSTA 2018 |
Retrospective case series | 21/21 | / | 84 months | 4.3 cm2(2.9-8.0) 11 MFC/3 LFC/6 Tro/1 Pat IV |
MFX and glued AMIC (Chondro-Gide) | AMIC was found to be an effective method to treat full-thickness knee chondral defects larger than 2 cm2, with significant clinical and functional improvement maintained over a 7-year follow-up | 58 |
| Schuttler et al. Arthroscopy 2018 |
Prospective case series | 28/28 | 35 ± 7 years — 27 ± 3 |
60 months | 3.7 ± 1.9 cm2
13 MFC/3 LFC/5 Pat/2 Tro III-IV |
Debridement and cell-free collagen type I gel matrix (CaReS-1S) | The use of this cell-free collagen type I scaffold for large defects showed increased wear of the repair tissue and clinical failure in 18% of cases at 5-year follow-up | 57 |
| Sofu et al. KSSTA 2018 |
Retrospective comparative study | 21/21 | 39 ± 10 years 9M /12 F 23 ± 1 |
24 months | 3.3 ± 0.7 cm2
MFC 16/LFC 5 III-IV |
Debridement, MFX + hyaluronic acid–based cell-free scaffold (Hyalofast) | Single-stage regenerative cartilage surgery using hyaluronic acid–based cell free scaffold in combination with MFX showed improvement of symptoms at final follow-up | 63 |
BMI = body mass index; MFC = medial femoral condyle; LFC = lateral femoral condyle; Pat = patella; Tro = trochlea; MFX = microfractures; AMIC = autologous matrix-induced chondrogenesis.