Long-Term Outcomes after Autologous Chondrocyte Implantation: A Systematic Review at Mean Follow-Up of 11.4 Years

Ayoosh Pareek, James L. Carey, Patrick J. Reardon, Lars Peterson, Michael J. Stuart, Aaron Krych

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective: Autologous chondrocyte implantation (ACI) has not been proven to be durable over the long-term. The purpose of this systematic review was (1) to evaluate activity level and knee function, (2) to evaluate reoperation and failure rates, and (3) to analyze risk factors for reoperation and failure of ACI at minimum long-term follow-up. Design: A comprehensive review was performed for studies with long-term outcomes after ACI for cartilage defect repair. Studies reported outcome scores such as Tegner score, Lysholm score, and International Knee Documentation Society (IKDC) score along with rates of failure and reoperation. Modified Coleman Methodology Scores were calculated to assess study methodological quality. Results: Nine studies with a total of 771 patients with a mean age of 33.4 ± 2.5 years, mean defect size of 5.9 ± 1.6 cm2, and mean follow-up of 11.4 years were included. Tegner score, Lysholm score, and IKDC score change from preoperative to final follow-up was 1.1 (95% CI 0.8-1.4, P < 0.001), 24.9 points (95% CI 18.8-31, P < 0.001), and 16.5 points (95% CI 5.4-27.5, P < 0.01), respectively. The mean failure and reoperation rates were 18% and 37%, respectively. Increased age and lesion size (>4.5 cm2) were significantly correlated with increased risk of reoperation and failure. Conclusions: Overall, ACI demonstrated successful outcomes in 82% of patients over the long-term. Increased patient age and lesion size greater than 4.5 cm2 were risk factors for a higher reoperation and failure rate. Nonetheless, this review is limited by heterogeneity in surgical technique, and lesion and patient characteristics.

Original languageEnglish (US)
Pages (from-to)298-308
Number of pages11
JournalCartilage
Volume7
Issue number4
DOIs
StatePublished - Oct 1 2016

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Chondrocytes
Reoperation
Defects
Documentation
Cartilage
Repair
Knee
Outcome Assessment (Health Care)
Lysholm Knee Score

Keywords

  • autologous chondrocyte implantation
  • cartilage
  • long-term

ASJC Scopus subject areas

  • Immunology and Allergy
  • Biomedical Engineering
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Long-Term Outcomes after Autologous Chondrocyte Implantation : A Systematic Review at Mean Follow-Up of 11.4 Years. / Pareek, Ayoosh; Carey, James L.; Reardon, Patrick J.; Peterson, Lars; Stuart, Michael J.; Krych, Aaron.

In: Cartilage, Vol. 7, No. 4, 01.10.2016, p. 298-308.

Research output: Contribution to journalArticle

Pareek, Ayoosh ; Carey, James L. ; Reardon, Patrick J. ; Peterson, Lars ; Stuart, Michael J. ; Krych, Aaron. / Long-Term Outcomes after Autologous Chondrocyte Implantation : A Systematic Review at Mean Follow-Up of 11.4 Years. In: Cartilage. 2016 ; Vol. 7, No. 4. pp. 298-308.
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AB - Objective: Autologous chondrocyte implantation (ACI) has not been proven to be durable over the long-term. The purpose of this systematic review was (1) to evaluate activity level and knee function, (2) to evaluate reoperation and failure rates, and (3) to analyze risk factors for reoperation and failure of ACI at minimum long-term follow-up. Design: A comprehensive review was performed for studies with long-term outcomes after ACI for cartilage defect repair. Studies reported outcome scores such as Tegner score, Lysholm score, and International Knee Documentation Society (IKDC) score along with rates of failure and reoperation. Modified Coleman Methodology Scores were calculated to assess study methodological quality. Results: Nine studies with a total of 771 patients with a mean age of 33.4 ± 2.5 years, mean defect size of 5.9 ± 1.6 cm2, and mean follow-up of 11.4 years were included. Tegner score, Lysholm score, and IKDC score change from preoperative to final follow-up was 1.1 (95% CI 0.8-1.4, P < 0.001), 24.9 points (95% CI 18.8-31, P < 0.001), and 16.5 points (95% CI 5.4-27.5, P < 0.01), respectively. The mean failure and reoperation rates were 18% and 37%, respectively. Increased age and lesion size (>4.5 cm2) were significantly correlated with increased risk of reoperation and failure. Conclusions: Overall, ACI demonstrated successful outcomes in 82% of patients over the long-term. Increased patient age and lesion size greater than 4.5 cm2 were risk factors for a higher reoperation and failure rate. Nonetheless, this review is limited by heterogeneity in surgical technique, and lesion and patient characteristics.

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