Prior procedures, graft location, preoperative physical health, postoperative strength and graft integrity are associated with 10‐year clinical outcome after matrix‐induced autologous chondrocyte implantation

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Abstract
Purpose: To investigate factors associated with 10‐year clinical scores after matrix‐induced autologous chondrocyte implantation (MACI). Methods: This retrospective case series included 143 MACI patients with 10‐year clinical and radiological follow‐up. Clinical assessment included the Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life (KOOS‐QOL) and sport and recreation (KOOS‐Sport/Rec) subscales, and patient satisfaction. Regression analysis investigated the contribution of patient (age, sex, body mass index and preoperative physical health), surgical (symptom duration, prior surgeries, defect size and location) and postoperative variables, such as knee extensor strength and a magnetic resonance imaging (MRI) composite graft score, to 10‐year clinical scores and being ‘very satisfied’. Results: The KOOS‐QOL ( p < 0.001) and KOOS‐Sport/Rec ( p < 0.0001) improved from baseline to 10 years, with 88 (61.5%) patients ‘very satisfied’ with their outcome. A lower number of prior surgical procedures, greater knee extensor strength, and a better 10‐year MRI score contributed significantly to a higher KOOS‐QOL. For the KOOS‐Sport/Rec, a lower number of prior surgical procedures, undergoing tibiofemoral (versus patellofemoral) MACI, greater preoperative physical health and a better 10‐year MRI score contributed significantly to a better score. Finally, a lower number of prior procedures and greater preoperative physical health contributed to a patient being ‘very satisfied’. Conclusion: Factors including the number of prior procedures, defect location, preoperative physical health, postoperative quadriceps strength and MRI‐based graft integrity were associated with improved 10‐year clinical scores. This information will permit more tailored patient discussion, along with the setting of realistic, longer‐term expectations for outcomes. Level of Evidence: Level IV.

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