CLINICAL EFFICACY OF OSTEOCHONDRAL AUTOGRAFT TRANSFER COMPARED WITH AUTOLOGOUS MATRIX-INDUCED CHONDROGENESIS USING A COLLAGEN MEMBRANE FOR FOCAL CHONDRAL AND OSTEOCHONDRAL LESIONS OF THE KNEE: A SYSTEMATIC REVIEW

Abstract

Objective: To synthesize and compare clinical, functional, radiological, and safety evidence on autologous matrix-induced chondrogenesis using a collagen membrane (AMIC) and osteochondral autograft transfer (OAT/OATS) for focal chondral and osteochondral lesions of the knee. Methods: A systematic review reported according to PRISMA 2020. PubMed/MEDLINE and SciELO, together with reference lists, were searched for clinical studies published from January 2016 to May 2026. Study selection and data extraction were performed independently. Risk of bias was assessed using design-specific instruments, and certainty of evidence was evaluated with the GRADE approach. Results: Of 430 records identified, 31 full-text articles were assessed and 29 were included in the qualitative synthesis: 16 investigated AMIC or its variations, 12 evaluated OAT/OATS, and one directly compared the techniques. Both approaches improved pain and function. AMIC showed stable clinical outcomes for up to 10 years and outperformed microfracture in randomized studies. OAT/OATS provided functional recovery, return to sport, and maintenance of outcomes at follow-up periods of up to 15-18 years, although reoperation rates varied. In the only direct comparison, AMIC produced a higher Lysholm score at two years; however, the retrospective design, small AMIC group, and imbalance in lesion size limited causal inference. Conclusion: AMIC and OAT/OATS are effective options for selected patients, but direct comparative evidence is insufficient to establish universal superiority. Treatment selection should consider lesion size, location and depth, subchondral bone involvement, functional demand, and knee biomechanics.