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Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques.

Abstract

BACKGROUND

Marrow stimulation techniques such as drilling or microfracture are first-line treatment options for symptomatic cartilage defects. Common knowledge holds that these treatments do not compromise subsequent cartilage repair procedures with autologous chondrocyte implantation.

HYPOTHESIS

Cartilage defects pretreated with marrow stimulation techniques will have an increased failure rate.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

The first 321 consecutive patients treated at one institution with autologous chondrocyte implantation for full-thickness cartilage defects that reached more than 2 years of follow-up were evaluated by prospectively collected data. Patients were grouped based on whether they had undergone prior treatment with a marrow stimulation technique. Outcomes were classified as complete failure if more than 25% of a grafted defect area had to be removed in later procedures because of persistent symptoms.

RESULTS

There were 522 defects in 321 patients (325 joints) treated with autologous chondrocyte implantation. On average, there were 1.7 lesions per patient. Of these joints, 111 had previously undergone surgery that penetrated the subchondral bone; 214 joints had no prior treatment that affected the subchondral bone and served as controls. Within the marrow stimulation group, there were 29 (26%) failures, compared with 17 (8%) failures in the control group.

CONCLUSION

Defects that had prior treatment affecting the subchondral bone failed at a rate 3 times that of nontreated defects. The failure rates for drilling (28%), abrasion arthroplasty (27%), and microfracture (20%) were not significantly different, possibly because of the lower number of microfracture patients in this cohort (25 of 110 marrow-stimulation procedures). The data demonstrate that marrow stimulation techniques have a strong negative effect on subsequent cartilage repair with autologous chondrocyte implantation and therefore should be used judiciously in larger cartilage defects that could require future treatment with autologous chondrocyte implantation.

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  • Authors+Show Affiliations

    ,

    Cartilage Repair Center, Brigham & Women's Hospital, Harvard Medical School, 850 Boylston Street, Chestnut Hill, MA 02467, USA.

    , , ,

    Source

    MeSH

    Adolescent
    Adult
    Arthroplasty, Subchondral
    Arthroscopy
    Cartilage, Articular
    Chondrocytes
    Debridement
    Female
    Humans
    Knee Injuries
    Knee Joint
    Male
    Middle Aged
    Regeneration
    Retrospective Studies
    Transplantation, Autologous
    Treatment Failure
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    19261905

    Citation

    Minas, Tom, et al. "Increased Failure Rate of Autologous Chondrocyte Implantation After Previous Treatment With Marrow Stimulation Techniques." The American Journal of Sports Medicine, vol. 37, no. 5, 2009, pp. 902-8.
    Minas T, Gomoll AH, Rosenberger R, et al. Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med. 2009;37(5):902-8.
    Minas, T., Gomoll, A. H., Rosenberger, R., Royce, R. O., & Bryant, T. (2009). Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. The American Journal of Sports Medicine, 37(5), pp. 902-8. doi:10.1177/0363546508330137.
    Minas T, et al. Increased Failure Rate of Autologous Chondrocyte Implantation After Previous Treatment With Marrow Stimulation Techniques. Am J Sports Med. 2009;37(5):902-8. PubMed PMID: 19261905.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. AU - Minas,Tom, AU - Gomoll,Andreas H, AU - Rosenberger,Ralf, AU - Royce,Ronald O, AU - Bryant,Tim, Y1 - 2009/03/04/ PY - 2009/3/6/entrez PY - 2009/3/6/pubmed PY - 2009/8/8/medline SP - 902 EP - 8 JF - The American journal of sports medicine JO - Am J Sports Med VL - 37 IS - 5 N2 - BACKGROUND: Marrow stimulation techniques such as drilling or microfracture are first-line treatment options for symptomatic cartilage defects. Common knowledge holds that these treatments do not compromise subsequent cartilage repair procedures with autologous chondrocyte implantation. HYPOTHESIS: Cartilage defects pretreated with marrow stimulation techniques will have an increased failure rate. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: The first 321 consecutive patients treated at one institution with autologous chondrocyte implantation for full-thickness cartilage defects that reached more than 2 years of follow-up were evaluated by prospectively collected data. Patients were grouped based on whether they had undergone prior treatment with a marrow stimulation technique. Outcomes were classified as complete failure if more than 25% of a grafted defect area had to be removed in later procedures because of persistent symptoms. RESULTS: There were 522 defects in 321 patients (325 joints) treated with autologous chondrocyte implantation. On average, there were 1.7 lesions per patient. Of these joints, 111 had previously undergone surgery that penetrated the subchondral bone; 214 joints had no prior treatment that affected the subchondral bone and served as controls. Within the marrow stimulation group, there were 29 (26%) failures, compared with 17 (8%) failures in the control group. CONCLUSION: Defects that had prior treatment affecting the subchondral bone failed at a rate 3 times that of nontreated defects. The failure rates for drilling (28%), abrasion arthroplasty (27%), and microfracture (20%) were not significantly different, possibly because of the lower number of microfracture patients in this cohort (25 of 110 marrow-stimulation procedures). The data demonstrate that marrow stimulation techniques have a strong negative effect on subsequent cartilage repair with autologous chondrocyte implantation and therefore should be used judiciously in larger cartilage defects that could require future treatment with autologous chondrocyte implantation. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/19261905/Increased_failure_rate_of_autologous_chondrocyte_implantation_after_previous_treatment_with_marrow_stimulation_techniques_ L2 - http://journals.sagepub.com/doi/full/10.1177/0363546508330137?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -