{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:20:37Z","timestamp":1793830837388,"version":"4.6.1"},"reference-count":75,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["CARTILAGE"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate efficacy and safety at 5 years after treatment with hydrogel-based autologous chondrocyte implantation (ACI) for large cartilage defects in the knee.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>\n                      Prospective, multicenter, single-arm, Phase III clinical trial. ACI was performed in 100 patients with focal full-thickness cartilage defects ranging from 4 to 12 cm\n                      <jats:sup>2<\/jats:sup>\n                      in size. The primary outcome measure was the responder rate (defined as improvement by \u226510 points) at 2 years using the Knee Injury and Osteoarthritis Outcome Score (KOOS).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The preoperative overall KOOS was 39.8 points and continuously increased to 84.7 points at 5 years (mean increase 44.1 points, 95% CI = 40.4-47.9,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001). The primary study endpoint (i.e., a KOOS responder rate of &gt;40%) was descriptively met at each assessment timepoint from 3 months to 5 years (Month 3: 75.5%, 95% CI = 65.6-83.8; Year 2: 93.0%, 95% CI = 86.1-97.1, Year 5: 92.8%, 95% CI = 85.7-97.0). International Knee Documentation Committee (IKDC) subjective and objective scores and quality of life assessments (EQ-5D-5L) supported the results seen for the KOOS. The overall treatment failure rate at 5 years was 1%. All treatment-related adverse events were of mild or moderate intensity and mostly occurred within the first year after treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hydrogel-based ACI has been shown to be a safe and effective treatment option for patients with large knee cartilage defects with sustained efficacy up to 5 years as demonstrated by consistent and clinically relevant improvements in all investigated efficacy variables. No remarkable adverse events or safety issues were noted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19476035251334737","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T05:48:48Z","timestamp":1745819328000},"page":"347-357","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Treatment of Large Cartilage Defects in the Knee by Hydrogel-Based Autologous Chondrocyte Implantation: A 5-Year Follow-Up of a Prospective, Multicenter, Single-Arm Phase III Trial"],"prefix":"10.1177","volume":"17","author":[{"given":"P.","family":"Niemeyer","sequence":"first","affiliation":[{"name":"OCM Clinic, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Hanus","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Praha, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Belickas","sequence":"additional","affiliation":[{"name":"Lithuanian University of Health Sciences, Ortopedijos Technika, Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"L\u00e1szl\u00f3","sequence":"additional","affiliation":[{"name":"Clinic of Traumatology, J\u00e1sz-Nagykun-Szolnok County Het\u00e9nyi G\u00e9za Hospital, Szolnok, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Gudas","sequence":"additional","affiliation":[{"name":"Hospital of Lithuanian University of Health Sciences, Kaunas Clinics, Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Fiodorovas","sequence":"additional","affiliation":[{"name":"Klaipeda University Hospital, Klaipeda, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Cebatorius","sequence":"additional","affiliation":[{"name":"Klaipeda University Hospital, Klaipeda, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Pastucha","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Hospital Ho\u0159ovice, Ho\u0159ovice, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Izadpanah","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert Ludwigs University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Proke\u0161","sequence":"additional","affiliation":[{"name":"Clinic of Traumatology, Faculty of Medicine, Masaryk University Brno and \u00darazov\u00e1 Nemocnice, Brno, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Sis\u00e1k","sequence":"additional","affiliation":[{"name":"Department of Traumatology and Orthopaedics, University of Szeged, Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Mohyla","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University Hospital Ostrava, Ostrava-Poruba, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Farkas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Szabolcs-Szatm\u00e1r-Bereg County Hospitals, University Teaching Hospital, Ny\u00edregyh\u00e1za, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.","family":"Kessler","sequence":"additional","affiliation":[{"name":"Centrum for Orthopaedics &amp; 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