Matrix-assisted autologous chondrocyte transplantation is effective at mid/long-term for knee lesions: A systematic review and meta-analysis

Purpose: This systematic review with meta-analysis evaluates the long-term efficacy of matrix-assisted autologous chondrocyte transplantation (MACT) in terms of functional scores using scaffolds made of hyaluronic acid (HA) or collagen (C).

Methods: Nineteen articles met the eligibility criteria for the analysis. Fourteen studies focused on patients treated with MACT with HA-based scaffolds, four studies with C-based scaffolds, and one study compared both scaffold types.

Results: A higher percentage of patients in the HA subgroup had undergone previous cartilage repair procedures, whereas multiple lesions were more common in the C subgroup. Both HA- and C-treated patients showed significant functional improvement in terms of International Knee Documentation Committee with overall mean differences at 2 and 5 years, and for HA-treated patients at 10 years. Likewise, concerning the Tegner activity scale, both subgroups demonstrated significant improvement at 2 years, with the HA subgroup showing more sustained improvement up to 10 years. The HA subgroup also had EQ-VAS reduction at 2, 5 and 10 years. Failure rates were similar between and within groups, with a range from 0% to 42% at different follow-ups.

Conclusion: Patients experienced mid-term benefits from MACT, using both HA-based and C-based scaffolds, and long-term benefits from using HA-based scaffolds. The low failure rate and the fact that most patients did not require knee replacement surgery are encouraging. Accordingly, despite their complexity and high costs, regenerative techniques like MACT are effective, as they can significantly delay or even prevent the need for total knee replacement.

Level of evidence: Level IV.