{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T23:04:16Z","timestamp":1773011056426,"version":"3.50.1"},"reference-count":46,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"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":["Knee surg. sports traumatol. arthrosc."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This registry study aimed to evaluate the safety and effectiveness of collagen membrane\u2010covered matrix\u2010associated autologous chondrocyte implantation (cMACI) versus periosteum\u2010covered MACI (pMACI) for large knee cartilage defects (Outerbridge III\u2013IV, \u22654\u2009cm\u00b2) in the femorotibial and\/or patellofemoral joints with a minimum 2\u2010year follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The safety analysis included 662 knees from 645 patients (mean age: 41.6\u2009\u00b1\u200914.0 years) with trauma (586 knees, 88.5%) or osteochondritis dissecans (76 knees, 11.5%). Mean final defect size after debridement was 6.6\u2009\u00b1\u20093.6\u2009cm\u00b2 (range: 4.0\u201338\u2009cm\u00b2), with \u22654\u2009cm\u00b2 in 101 knees (15.3%) receiving cMACI and 561 (84.7%) receiving pMACI. Adverse events (AEs) were assessed through physical examination, magnetic resonance imaging (MRI) and arthroscopy. AEs rates were compared between cMACI and pMACI. The effectiveness was assessed using the Lysholm Knee Score (LKS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 6, 12 and 24 months postoperatively. A mixed\u2010effects model for repeated measures was used for comparative analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Analyses showed no significant differences in patient characteristics between groups, except for age (older in the cMACI group), sex (predominantly female), disease aetiology (predominantly trauma) and meniscectomy prevalence (lower). cMACI showed reduced rates of graft hypertrophy (1.0% vs. 10.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0176), delamination (5.9% vs. 14.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0350), ossification (0% vs. 2.3%, not applicable), contracture (1.0% vs. 8.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0302) and treatment failure (3% vs. 9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0037). The per\u2010protocol set assessing effectiveness included 509 knees (cMACI\/pMACI: 70\/439), with no significant differences in patient characteristics between groups. The results demonstrated similar postoperative improvements in LKS and KOOS in both groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>cMACI showed superior safety compared with pMACI for large cartilage defects, with similarly improved outcomes in approximately 75% of patients. These findings suggest that the collagen membrane may address periosteum\u2010related AEs and treatment failures in MACI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level II.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70352","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T17:27:36Z","timestamp":1772990856000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Collagen\u2010membrane\u2010covered matrix\u2010associated chondrocyte implantation improves safety over periosteum\u2010covered MACI for large knee cartilage defects: A real\u2010world data analysis in the registry study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5858-9861","authenticated-orcid":false,"given":"Yuji","family":"Uchio","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Shimane University School of Medicine Izumo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5097-7264","authenticated-orcid":false,"given":"Ryosuke","family":"Kuroda","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Kobe University Graduate School of Medicine Kobe Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0197-5171","authenticated-orcid":false,"given":"Yasuo","family":"Niki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, School of Medicine Keio University Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2924-6156","authenticated-orcid":false,"given":"Katsura","family":"Sugawara","sequence":"additional","affiliation":[{"name":"Japan Tissue Engineering Co., Ltd. Gamagori Aichi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2180-7922","authenticated-orcid":false,"given":"Yasuyuki","family":"Ishibash","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hirosaki University Graduate School of Medicine Hirosaki 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