Cell-Seeded Autologous Chondrocyte Implantation: A Simplified Implantation Technique That Maintains High Clinical Outcomes
| Autor: | Amy Phan, Marissa Mastrocola, Andreas H. Gomoll, Nehal Shah, Luiz Felipe Ambra |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Cartilage Articular Male medicine.medical_specialty Knee Joint Cell Pain Physical Therapy Sports Therapy and Rehabilitation Knee Injuries Transplantation Autologous Chondrocyte Cohort Studies 03 medical and health sciences Young Adult 0302 clinical medicine Chondrocytes medicine Humans Orthopedics and Sports Medicine Orthopedic Procedures Autologous chondrocyte implantation Cartilage repair 030222 orthopedics business.industry Collagen membrane 030229 sport sciences Osteoarthritis Knee Magnetic Resonance Imaging Surgery medicine.anatomical_structure Female Collagen Knee injuries business Cohort study |
| Zdroj: | The American journal of sports medicine. 45(5) |
| ISSN: | 1552-3365 |
| Popis: | Background:The use of autologous chondrocyte implantation (ACI) remains limited, even though multiple studies have demonstrated success rates exceeding 75%. The procedure is perceived as invasive and technically challenging, presenting barriers to more widespread adoption.Purpose/Hypothesis:The objective of this study was to investigate whether outcomes and the failure rate of a simplified ACI technique (cs-ACI) were comparable with those of the more complicated traditional technique of a chondrocyte suspension injected under a collagen membrane (cACI). We hypothesized that the change in technique would not negatively affect outcomes.Study Design:Cohort study; Level of evidence, 3.Methods:Thirty-nine patients treated with the cs-ACI technique fulfilled the inclusion requirements. A group of 45 patients treated previously with standard cACI was used as a comparison. The functional outcomes were prospectively collected both preoperatively and postoperatively at the last follow-up. Failure was defined as any graft removal of more than 25% of the original defect size. Magnetic resonance imaging was performed postoperatively, and scans were assessed using a modified MOCART (magnetic resonance observation of cartilage repair tissue) scoring system.Results:Group demographics were not significantly different, except for the defect size and mean follow-up: 4.09 years in the cACI group and 2.46 years in the cs-ACI group. Significant improvements were seen in all outcome measures except the Tegner score from the preoperative baseline to the latest follow-up for both the cACI group (International Knee Documentation Committee [IKDC] score, from 42.0 to 63.4; Knee injury and Osteoarthritis Outcome Score [KOOS]–Pain subscore, from 58.7 to 77.1; Lysholm score, from 57.2 to 69.7; and Tegner score, from 3.5 to 4.2) and the cs-ACI group (IKDC score, from 45.6 to 68.0; KOOS-Pain subscore, from 66.6 to 84.7; Lysholm score, from 53.7 to 75.4; and Tegner score, from 3.2 to 3.8). No significant difference was found between the groups at the latest follow-up. The failure rate at 2 years was not significantly different, while the total failure rate over the entire study period was significantly lower in the cs-ACI group than the cACI group (5% vs 24%, respectively). The overall MOCART score was not significantly different between the groups.Conclusion:The treatment of full-thickness articular cartilage defects with a simplified cell-seeded ACI technique demonstrated no significant differences in the failure rate and patient-reported outcomes when compared with a standard technique utilizing interrupted sutures and the injection of a cell suspension under a collagen membrane. |
| Databáze: | OpenAIRE |
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