Affiliation:
1. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
2. Rush Cartilage Restoration Center, Rush University Medical Center, Chicago, Illinois
Abstract
Background Autologous chondrocyte implantation is indicated as a second-line treatment of large, irregularly shaped chondral defects after failure of first-line surgical intervention. This study examines the clinical results of a patient cohort undergoing autologous chondrocyte implantation and elucidates factors associated with subjective improvement after implantation. Hypothesis Autologous chondrocyte implantation will result in long-term functional and symptomatic improvement. Study Design Case series; Level of evidence, 4. Methods The cohort included 137 subjects (140 knees) who underwent autologous chondrocyte implantation of the knee. Mean defect size per patient was 5.2 ± 3.5 cm2 (range, 0.8-26.6 cm2). Patients averaged 30.3 ± 9.1 years of age (range, 13.9-49.9 years) and were followed for 4.3 ± 1.8 years (range, 2.0-9.7 years). Outcomes were assessed via clinical assessment and established outcome scales, including the Lysholm scale, International Knee Documentation Committee scale, and Short Form-12. Results A significant improvement after surgery was observed in all outcome assessments including the Lysholm (41 to 69; P < .001) and International Knee Documentation Committee (34 to 64; P < .001) scales. Subjectively, 75% of patients indicated they were completely or mostly satisfied with the outcome and 83% would have the procedure again. Preoperatively, 32% of patients had a Tegner score of 6 or greater, compared with 82% before injury and 65% at most recent follow-up. Multivariate analysis identified age (P < .021) and receiving workers’ compensation (P < .018) as independent predictors of follow-up Lysholm score. Twenty-one patients (16%) required debridement of the autologous chondrocyte implantation site secondary to persistent symptoms, whereas 9 knees (6.4%) clinically failed and underwent a revision procedure. Conclusion Autologous chondrocyte implantation is a viable treatment option for chondral defects of the knee, resulting in durable functional and symptomatic improvement. Age and workers’ compensation status are independent predictors of outcome.
Subject
Physical Therapy, Sports Therapy and Rehabilitation,Orthopedics and Sports Medicine
Cited by
98 articles.
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