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Clinical Outcomes After Autologous Chondrocyte Implantation in Adolescents' Knees: A Systematic Review.
Arthroscopy 2016; 32(9):1905-16A

Abstract

PURPOSE

To perform a systematic review of the use of autologous chondrocyte implantation (ACI) in the adolescent knee.

SPECIFIC AIMS

(1) quantify clinical outcomes of ACI in adolescent knees, (2) identify lesion and patient factors that correlate with clinical outcome, and (3) determine the incidence of complications of ACI in adolescents.

METHODS

PubMed, MEDLINE, SCOPUS, CINAHL, and Cochrane Collaboration Library databases were searched systematically. Outcome scores recorded included the International Knee Documentation Committee score, the International Cartilage Repair Society score, the Knee Injury and Osteoarthritis Outcome Score, the visual analog scale, the Bentley Functional Rating Score, the Modified Cincinnati Rating System, Tegner activity Lysholm scores, and return athletics. Outcome scores were compared among studies based on proportion of adolescents achieving specific outcome quartiles at a minimum 1-year follow-up. Methodologic quality of studies was evaluated by Coleman Methodology Scores (CMSs).

RESULTS

Five studies reported on 115 subjects who underwent ACI with periosteal cover (ACI-P; 95, 83%), ACI with type I/type III collagen cover (ACI-C; 6, 5%), or matrix-induced ACI (MACI; 14, 12%). Mean patient age was 16.2 years (range, 11 to 21 years). All studies were case series. Follow-up ranged from 12 to 74 months (mean, 52.3 months). Mean defect size was 5.3 cm(2) (range, 0.96 to 14 cm(2)). All studies reported improvement in clinical outcomes scores. Graft hypertrophy was the most common complication (7.0%). The mean preoperative clinical outcome percentage (based on percentage of outcome scale used) was 37% (standard deviation [SD], 18.9%) and the mean postoperative clinical outcome percentage was 72.7% (SD, 16.9%). The overall percentage increase in clinical outcome scores was 35.7% (SD, 14.2%). Mean CMS was 47.8 (SD, 8.3).

CONCLUSIONS

Cartilage repair in adolescent knees using ACI provides success across different clinical outcomes measures. The only patient- or lesion-specific factor that influenced clinical outcome was the shorter duration of preoperative symptoms.

LEVEL OF EVIDENCE

Level IV, systemic review of Level I-IV studies.

Authors+Show Affiliations

The Ohio State University College of Medicine, Columbus, Ohio, U.S.A.The Ohio State University College of Medicine, Columbus, Ohio, U.S.A.Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.; Cartilage Restoration Program, Columbus, Ohio, U.S.A.. Electronic address: david.flanigan@osumc.edu.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

27161508

Citation

DiBartola, Alex C., et al. "Clinical Outcomes After Autologous Chondrocyte Implantation in Adolescents' Knees: a Systematic Review." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 32, no. 9, 2016, pp. 1905-16.
DiBartola AC, Wright BM, Magnussen RA, et al. Clinical Outcomes After Autologous Chondrocyte Implantation in Adolescents' Knees: A Systematic Review. Arthroscopy. 2016;32(9):1905-16.
DiBartola, A. C., Wright, B. M., Magnussen, R. A., & Flanigan, D. C. (2016). Clinical Outcomes After Autologous Chondrocyte Implantation in Adolescents' Knees: A Systematic Review. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 32(9), pp. 1905-16. doi:10.1016/j.arthro.2016.03.007.
DiBartola AC, et al. Clinical Outcomes After Autologous Chondrocyte Implantation in Adolescents' Knees: a Systematic Review. Arthroscopy. 2016;32(9):1905-16. PubMed PMID: 27161508.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical Outcomes After Autologous Chondrocyte Implantation in Adolescents' Knees: A Systematic Review. AU - DiBartola,Alex C, AU - Wright,Brennan M, AU - Magnussen,Robert A, AU - Flanigan,David C, Y1 - 2016/05/07/ PY - 2016/02/22/received PY - 2016/03/02/revised PY - 2016/03/04/accepted PY - 2016/5/11/entrez PY - 2016/5/11/pubmed PY - 2017/10/12/medline SP - 1905 EP - 16 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 32 IS - 9 N2 - PURPOSE: To perform a systematic review of the use of autologous chondrocyte implantation (ACI) in the adolescent knee. SPECIFIC AIMS: (1) quantify clinical outcomes of ACI in adolescent knees, (2) identify lesion and patient factors that correlate with clinical outcome, and (3) determine the incidence of complications of ACI in adolescents. METHODS: PubMed, MEDLINE, SCOPUS, CINAHL, and Cochrane Collaboration Library databases were searched systematically. Outcome scores recorded included the International Knee Documentation Committee score, the International Cartilage Repair Society score, the Knee Injury and Osteoarthritis Outcome Score, the visual analog scale, the Bentley Functional Rating Score, the Modified Cincinnati Rating System, Tegner activity Lysholm scores, and return athletics. Outcome scores were compared among studies based on proportion of adolescents achieving specific outcome quartiles at a minimum 1-year follow-up. Methodologic quality of studies was evaluated by Coleman Methodology Scores (CMSs). RESULTS: Five studies reported on 115 subjects who underwent ACI with periosteal cover (ACI-P; 95, 83%), ACI with type I/type III collagen cover (ACI-C; 6, 5%), or matrix-induced ACI (MACI; 14, 12%). Mean patient age was 16.2 years (range, 11 to 21 years). All studies were case series. Follow-up ranged from 12 to 74 months (mean, 52.3 months). Mean defect size was 5.3 cm(2) (range, 0.96 to 14 cm(2)). All studies reported improvement in clinical outcomes scores. Graft hypertrophy was the most common complication (7.0%). The mean preoperative clinical outcome percentage (based on percentage of outcome scale used) was 37% (standard deviation [SD], 18.9%) and the mean postoperative clinical outcome percentage was 72.7% (SD, 16.9%). The overall percentage increase in clinical outcome scores was 35.7% (SD, 14.2%). Mean CMS was 47.8 (SD, 8.3). CONCLUSIONS: Cartilage repair in adolescent knees using ACI provides success across different clinical outcomes measures. The only patient- or lesion-specific factor that influenced clinical outcome was the shorter duration of preoperative symptoms. LEVEL OF EVIDENCE: Level IV, systemic review of Level I-IV studies. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/27161508/Clinical_Outcomes_After_Autologous_Chondrocyte_Implantation_in_Adolescents'_Knees:_A_Systematic_Review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(16)00246-2 DB - PRIME DP - Unbound Medicine ER -