{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:51:37Z","timestamp":1792083097693,"version":"4.4.0"},"reference-count":56,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":86,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Atelocollagen\u2010associated autologous chondrocyte implantation (A\u2010ACI) with periosteal coverage shows favourable outcomes for large knee cartilage defects but is associated with complications such as graft hypertrophy. Collagen membrane coverage remains under\u2010investigated in this technique. This study aimed to evaluate periosteal versus collagen membrane coverage using clinical, radiological, arthroscopic and histological assessments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Between 2014 and 2022, patients with \u22654.0\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      full\u2010thickness chondral lesions underwent A\u2010ACI using periosteal (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913) or collagen membrane (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913) coverage in a non\u2010randomized sequential comparative study. Clinical and radiological outcomes were assessed at 12 and 24 months using the Lysholm score, Knee injury and Osteoarthritis Outcome Score and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score. Second\u2010look arthroscopy included International Cartilage Repair Society (ICRS) and Oswestry Arthroscopy Score (OAS) assessments, with histological analysis using the ICRS II scoring system. Minimum follow\u2010up was 24 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both groups demonstrated significant clinical improvement at 24 months without significant between\u2010group differences. MOCART 2.0 scores were significantly higher in the collagen membrane group at 12 and 24 months (83 vs. 60 at 24 months,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). OAS scores were significantly higher in the collagen membrane group (8.5 vs. 6.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034), while ICRS scores were comparable. Histological parameters, including tissue morphology, basal integration and subchondral bone quality, were significantly higher in the collagen membrane group. Complication profiles differed: graft hypertrophy and delamination in the periosteal group (46%) versus subchondral bone cysts in the collagen membrane group (15%). Collagen membrane coverage remained associated with higher MOCART 2.0 scores after limited adjustment for concomitant osteotomy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The primary clinical outcomes improved similarly in both groups at two years without meaningful between\u2010group superiority. While collagen membrane coverage was associated with higher MOCART 2.0 scores after adjustment for concomitant osteotomy, all structural evaluations should be regarded strictly as secondary and exploratory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70924","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:34:46Z","timestamp":1790361286000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal evaluation of periosteal versus collagen membrane coverage in atelocollagen\u2010associated autologous chondrocyte implantation for large knee cartilage defects"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7824-699X","authenticated-orcid":false,"given":"Takuma","family":"Kaibara","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Hokkaido University Graduate School of Medicine Sapporo Hokkaido Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2139-5059","authenticated-orcid":false,"given":"Eiji","family":"Kondo","sequence":"additional","affiliation":[{"name":"Centre for Sports Medicine Hokkaido University Hospital Sapporo Hokkaido Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hokkaido University Graduate School of Medicine Sapporo Hokkaido 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