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Long-term outcomes after first-generation autologous chondrocyte implantation for cartilage defects of the knee.
Am J Sports Med 2014; 42(1):150-7AJ

Abstract

BACKGROUND

Autologous chondrocyte implantation (ACI) represents an established surgical therapy for large cartilage defects of the knee joint. Although various studies report satisfying midterm results, little is known about long-term outcomes.

PURPOSE

To evaluate long-term clinical and magnetic resonance imaging (MRI) outcomes after ACI.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Between January 1997 and June 2001, a total of 86 patients were treated with ACI for isolated cartilage defects of the knee. The mean patient age at the time of surgery was 33.3 ± 10.2 years, and the mean defect size was 6.5 ± 4.0 cm(2). Thirty-four defects were located on the medial femoral condyle and 13 on the lateral femoral condyle, while 6 patients were treated for cartilage defects of the trochlear groove and 17 for patellar lesions. At a mean follow-up of 10.9 ± 1.1 years, 70 patients (follow-up rate, 82%) treated for 82 full-thickness cartilage defects of the knee were available for an evaluation of knee function using standard instruments, while 59 of these patients were additionally evaluated by 1.5-T MRI to quantify the magnetic resonance observation of cartilage repair tissue (MOCART) score. Clinical function at follow-up was assessed by means of the Lysholm score, the International Knee Documentation Committee (IKDC) score, and the Knee injury and Osteoarthritis Outcome Score (KOOS). Patient activity was assessed by the Tegner score. In addition, pain on a visual analog scale (VAS) and patient satisfaction were evaluated separately.

RESULTS

At follow-up, 77% reported being "satisfied" or "very satisfied." The mean IKDC score at follow-up was 74.0 ± 17.3. The mean Lysholm score improved from 42.0 ± 22.5 before surgery to 71.0 ± 17.4 at follow-up (P < .01). The mean pain score on the VAS decreased from 7.2 ± 1.9 preoperatively to 2.1 ± 2.1 postoperatively. The mean MOCART score was 44.9 ± 23.6. Defect-associated bone marrow edema was found in 78% of the cases. Nevertheless, no correlation between the MOCART score and clinical outcome (IKDC score) could be found (Pearson coefficient, r = 0.173).

CONCLUSION

First-generation ACI leads to satisfying clinical results in terms of patient satisfaction, reduction of pain, and improvement in knee function. Nevertheless, full restoration of knee function cannot be achieved. Although MRI reveals lesions in the majority of the cases and the overall MOCART score seems moderate, this could not be correlated with long-term clinical outcomes.

Authors+Show Affiliations

Philipp Niemeyer, Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Strasse 55, D-79095 Freiburg, Germany. philipp.niemeyer@uniklinik-freiburg.de.

Pub Type(s)

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

Language

eng

PubMed ID

24145948

Citation

Niemeyer, Philipp, et al. "Long-term Outcomes After First-generation Autologous Chondrocyte Implantation for Cartilage Defects of the Knee." The American Journal of Sports Medicine, vol. 42, no. 1, 2014, pp. 150-7.
Niemeyer P, Porichis S, Steinwachs M, et al. Long-term outcomes after first-generation autologous chondrocyte implantation for cartilage defects of the knee. Am J Sports Med. 2014;42(1):150-7.
Niemeyer, P., Porichis, S., Steinwachs, M., Erggelet, C., Kreuz, P. C., Schmal, H., ... Salzmann, G. (2014). Long-term outcomes after first-generation autologous chondrocyte implantation for cartilage defects of the knee. The American Journal of Sports Medicine, 42(1), pp. 150-7. doi:10.1177/0363546513506593.
Niemeyer P, et al. Long-term Outcomes After First-generation Autologous Chondrocyte Implantation for Cartilage Defects of the Knee. Am J Sports Med. 2014;42(1):150-7. PubMed PMID: 24145948.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term outcomes after first-generation autologous chondrocyte implantation for cartilage defects of the knee. AU - Niemeyer,Philipp, AU - Porichis,Stella, AU - Steinwachs,Matthias, AU - Erggelet,Christoph, AU - Kreuz,Peter C, AU - Schmal,Hagen, AU - Uhl,Markus, AU - Ghanem,Nadir, AU - Südkamp,Norbert P, AU - Salzmann,Gian, Y1 - 2013/10/21/ PY - 2013/10/23/entrez PY - 2013/10/23/pubmed PY - 2014/11/5/medline KW - autologous chondrocyte implantation KW - cartilage KW - knee joint KW - long-term outcomes SP - 150 EP - 7 JF - The American journal of sports medicine JO - Am J Sports Med VL - 42 IS - 1 N2 - BACKGROUND: Autologous chondrocyte implantation (ACI) represents an established surgical therapy for large cartilage defects of the knee joint. Although various studies report satisfying midterm results, little is known about long-term outcomes. PURPOSE: To evaluate long-term clinical and magnetic resonance imaging (MRI) outcomes after ACI. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between January 1997 and June 2001, a total of 86 patients were treated with ACI for isolated cartilage defects of the knee. The mean patient age at the time of surgery was 33.3 ± 10.2 years, and the mean defect size was 6.5 ± 4.0 cm(2). Thirty-four defects were located on the medial femoral condyle and 13 on the lateral femoral condyle, while 6 patients were treated for cartilage defects of the trochlear groove and 17 for patellar lesions. At a mean follow-up of 10.9 ± 1.1 years, 70 patients (follow-up rate, 82%) treated for 82 full-thickness cartilage defects of the knee were available for an evaluation of knee function using standard instruments, while 59 of these patients were additionally evaluated by 1.5-T MRI to quantify the magnetic resonance observation of cartilage repair tissue (MOCART) score. Clinical function at follow-up was assessed by means of the Lysholm score, the International Knee Documentation Committee (IKDC) score, and the Knee injury and Osteoarthritis Outcome Score (KOOS). Patient activity was assessed by the Tegner score. In addition, pain on a visual analog scale (VAS) and patient satisfaction were evaluated separately. RESULTS: At follow-up, 77% reported being "satisfied" or "very satisfied." The mean IKDC score at follow-up was 74.0 ± 17.3. The mean Lysholm score improved from 42.0 ± 22.5 before surgery to 71.0 ± 17.4 at follow-up (P < .01). The mean pain score on the VAS decreased from 7.2 ± 1.9 preoperatively to 2.1 ± 2.1 postoperatively. The mean MOCART score was 44.9 ± 23.6. Defect-associated bone marrow edema was found in 78% of the cases. Nevertheless, no correlation between the MOCART score and clinical outcome (IKDC score) could be found (Pearson coefficient, r = 0.173). CONCLUSION: First-generation ACI leads to satisfying clinical results in terms of patient satisfaction, reduction of pain, and improvement in knee function. Nevertheless, full restoration of knee function cannot be achieved. Although MRI reveals lesions in the majority of the cases and the overall MOCART score seems moderate, this could not be correlated with long-term clinical outcomes. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/24145948/Long_term_outcomes_after_first_generation_autologous_chondrocyte_implantation_for_cartilage_defects_of_the_knee_ L2 - http://journals.sagepub.com/doi/full/10.1177/0363546513506593?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -