Autologous chondrocyte implantation for treatment of cartilage defects of the knee

what predicts the need for reintervention?

Pia M Jungmann, Gian M Salzmann, Hagen Schmal, Jan M Pestka, Norbert P Südkamp, Philipp Niemeyer

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

BACKGROUND: Autologous chondrocyte implantation (ACI) is a well-established treatment option for isolated cartilage defects of the knee joint, providing satisfying outcome. However, cases of treatment failure with the need for surgical reintervention are reported; typical patient's individual and environmental risk factors have previously not been described.

HYPOTHESIS: The need for reintervention after ACI is associated with specific preoperative detectable individual risk factors.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: A total of 413 patients following ACI (first, second, and third generation) were filtered for those who required revision surgery during their follow-up time (2-11.8 years). Factors were analyzed that might have significant effects on increased revision rate. Using preoperatively collected data, all patients were grouped according to 12 standard prognostic factors. Apart from odds ratio and Pearson χ(2) test, statistical analysis of risk factors was performed with multivariate binary logistic regression models and Cox regression, the method of choice for survival time data.

RESULTS: After a follow-up of 4.4 ± 0.9 years (limited to 5 years), a total of 88 patients (21.3%) had undergone surgical revision. The time to revision surgery was 1.8 ± 1.1 years. Four prognostic factors associated with a significantly higher risk for reintervention were detected: (1) female gender (Cox survival fit: P = .033), (2) previous surgeries of the affected joint (P = .002), (3) previous bone marrow stimulation (P = .041), and (4) periosteum patch-covered ACI (P = .028). An influence of patient age, body mass index (BMI), defect number, defect size, lesion origin, lesion location, parallel treatment, or smoking on the risk for reintervention could not be observed.

CONCLUSION: The study identifies clear facts that significantly increase the risk of revision surgery. These facts can be easily obtained preoperatively and may be taken into consideration when indicating ACI.

OriginalsprogEngelsk
TidsskriftAmerican Journal of Sports Medicine
Vol/bind40
Udgave nummer1
Sider (fra-til)58-67
ISSN0363-5465
DOI
StatusUdgivet - 2012
Udgivet eksterntJa

Fingeraftryk

Chondrocytes
Knee
Reoperation
Logistic Models
Periosteum
Knee Joint
Treatment Failure
Body Mass Index
Cohort Studies
Joints
Smoking
Odds Ratio

Citer dette

Jungmann, Pia M ; Salzmann, Gian M ; Schmal, Hagen ; Pestka, Jan M ; Südkamp, Norbert P ; Niemeyer, Philipp. / Autologous chondrocyte implantation for treatment of cartilage defects of the knee : what predicts the need for reintervention?. I: American Journal of Sports Medicine. 2012 ; Bind 40, Nr. 1. s. 58-67.
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title = "Autologous chondrocyte implantation for treatment of cartilage defects of the knee: what predicts the need for reintervention?",
abstract = "BACKGROUND: Autologous chondrocyte implantation (ACI) is a well-established treatment option for isolated cartilage defects of the knee joint, providing satisfying outcome. However, cases of treatment failure with the need for surgical reintervention are reported; typical patient's individual and environmental risk factors have previously not been described.HYPOTHESIS: The need for reintervention after ACI is associated with specific preoperative detectable individual risk factors.STUDY DESIGN: Cohort study; Level of evidence, 3.METHODS: A total of 413 patients following ACI (first, second, and third generation) were filtered for those who required revision surgery during their follow-up time (2-11.8 years). Factors were analyzed that might have significant effects on increased revision rate. Using preoperatively collected data, all patients were grouped according to 12 standard prognostic factors. Apart from odds ratio and Pearson χ(2) test, statistical analysis of risk factors was performed with multivariate binary logistic regression models and Cox regression, the method of choice for survival time data.RESULTS: After a follow-up of 4.4 ± 0.9 years (limited to 5 years), a total of 88 patients (21.3{\%}) had undergone surgical revision. The time to revision surgery was 1.8 ± 1.1 years. Four prognostic factors associated with a significantly higher risk for reintervention were detected: (1) female gender (Cox survival fit: P = .033), (2) previous surgeries of the affected joint (P = .002), (3) previous bone marrow stimulation (P = .041), and (4) periosteum patch-covered ACI (P = .028). An influence of patient age, body mass index (BMI), defect number, defect size, lesion origin, lesion location, parallel treatment, or smoking on the risk for reintervention could not be observed.CONCLUSION: The study identifies clear facts that significantly increase the risk of revision surgery. These facts can be easily obtained preoperatively and may be taken into consideration when indicating ACI.",
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Autologous chondrocyte implantation for treatment of cartilage defects of the knee : what predicts the need for reintervention? / Jungmann, Pia M; Salzmann, Gian M; Schmal, Hagen; Pestka, Jan M; Südkamp, Norbert P; Niemeyer, Philipp.

I: American Journal of Sports Medicine, Bind 40, Nr. 1, 2012, s. 58-67.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Autologous chondrocyte implantation for treatment of cartilage defects of the knee

T2 - what predicts the need for reintervention?

AU - Jungmann, Pia M

AU - Salzmann, Gian M

AU - Schmal, Hagen

AU - Pestka, Jan M

AU - Südkamp, Norbert P

AU - Niemeyer, Philipp

PY - 2012

Y1 - 2012

N2 - BACKGROUND: Autologous chondrocyte implantation (ACI) is a well-established treatment option for isolated cartilage defects of the knee joint, providing satisfying outcome. However, cases of treatment failure with the need for surgical reintervention are reported; typical patient's individual and environmental risk factors have previously not been described.HYPOTHESIS: The need for reintervention after ACI is associated with specific preoperative detectable individual risk factors.STUDY DESIGN: Cohort study; Level of evidence, 3.METHODS: A total of 413 patients following ACI (first, second, and third generation) were filtered for those who required revision surgery during their follow-up time (2-11.8 years). Factors were analyzed that might have significant effects on increased revision rate. Using preoperatively collected data, all patients were grouped according to 12 standard prognostic factors. Apart from odds ratio and Pearson χ(2) test, statistical analysis of risk factors was performed with multivariate binary logistic regression models and Cox regression, the method of choice for survival time data.RESULTS: After a follow-up of 4.4 ± 0.9 years (limited to 5 years), a total of 88 patients (21.3%) had undergone surgical revision. The time to revision surgery was 1.8 ± 1.1 years. Four prognostic factors associated with a significantly higher risk for reintervention were detected: (1) female gender (Cox survival fit: P = .033), (2) previous surgeries of the affected joint (P = .002), (3) previous bone marrow stimulation (P = .041), and (4) periosteum patch-covered ACI (P = .028). An influence of patient age, body mass index (BMI), defect number, defect size, lesion origin, lesion location, parallel treatment, or smoking on the risk for reintervention could not be observed.CONCLUSION: The study identifies clear facts that significantly increase the risk of revision surgery. These facts can be easily obtained preoperatively and may be taken into consideration when indicating ACI.

AB - BACKGROUND: Autologous chondrocyte implantation (ACI) is a well-established treatment option for isolated cartilage defects of the knee joint, providing satisfying outcome. However, cases of treatment failure with the need for surgical reintervention are reported; typical patient's individual and environmental risk factors have previously not been described.HYPOTHESIS: The need for reintervention after ACI is associated with specific preoperative detectable individual risk factors.STUDY DESIGN: Cohort study; Level of evidence, 3.METHODS: A total of 413 patients following ACI (first, second, and third generation) were filtered for those who required revision surgery during their follow-up time (2-11.8 years). Factors were analyzed that might have significant effects on increased revision rate. Using preoperatively collected data, all patients were grouped according to 12 standard prognostic factors. Apart from odds ratio and Pearson χ(2) test, statistical analysis of risk factors was performed with multivariate binary logistic regression models and Cox regression, the method of choice for survival time data.RESULTS: After a follow-up of 4.4 ± 0.9 years (limited to 5 years), a total of 88 patients (21.3%) had undergone surgical revision. The time to revision surgery was 1.8 ± 1.1 years. Four prognostic factors associated with a significantly higher risk for reintervention were detected: (1) female gender (Cox survival fit: P = .033), (2) previous surgeries of the affected joint (P = .002), (3) previous bone marrow stimulation (P = .041), and (4) periosteum patch-covered ACI (P = .028). An influence of patient age, body mass index (BMI), defect number, defect size, lesion origin, lesion location, parallel treatment, or smoking on the risk for reintervention could not be observed.CONCLUSION: The study identifies clear facts that significantly increase the risk of revision surgery. These facts can be easily obtained preoperatively and may be taken into consideration when indicating ACI.

KW - Adult

KW - Arthroscopy

KW - Cartilage, Articular

KW - Chi-Square Distribution

KW - Chondrocytes

KW - Female

KW - Fibrin Tissue Adhesive

KW - Follow-Up Studies

KW - Humans

KW - Knee Injuries

KW - Logistic Models

KW - Male

KW - Membranes, Artificial

KW - Periosteum

KW - Prognosis

KW - Proportional Hazards Models

KW - Reoperation

KW - Risk Factors

KW - Tissue Adhesives

KW - Transplantation, Autologous

KW - Treatment Outcome

KW - Journal Article

U2 - 10.1177/0363546511423522

DO - 10.1177/0363546511423522

M3 - Journal article

VL - 40

SP - 58

EP - 67

JO - American Journal of Sports Medicine

JF - American Journal of Sports Medicine

SN - 0363-5465

IS - 1

ER -