Autologous Chondrocyte Implantation versus Debridement for Treatment of Full-Thickness Chondral Defects of the Knee An Observational Cohort Study with 3-Year Follow-up

• Published in: The American journal of sports medicine Vol. 33; no. 11; pp. 1658 - 1666
• Main Authors: Fu, Freddie H., Zurakowski, David, Browne, Jon E., Mandelbaum, Bert, Erggelet, Christoph, Moseley, J. Bruce, Anderson, Allen F., Micheli, Lyle J.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-11-2005; American Orthopaedic Society for Sports Medicine; Sage Publications, Inc; Sage Publications Ltd
• Subjects: Adult; Athletes; Biological and medical sciences; Care and treatment; Cartilage; Cartilage, Articular - injuries; Cartilage, Articular - surgery; Chondrocytes - transplantation; Cohort Studies; Comparative analysis; Debridement; Diagnosis; Female; Femur - pathology; Fundamental and applied biological sciences. Psychology; Health aspects; Humans; Injuries; Knee; Knee injuries; Knee Injuries - pathology; Knee Injuries - surgery; Male; Medical sciences; Medical treatment; Middle Aged; Orthopedic Procedures - methods; Orthopedic surgery; Osteoarthritis; Pain; Range of Motion, Articular; Retrospective Studies; Sport (general aspects); Sports injuries; Sports medicine; Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Transplantation, Autologous; Transplants & implants; Traumas. Diseases due to physical agents; Treatment Outcome; Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports; United States; knee; autologous chondrocyte implantation (ACI); chondral defects; debridement; outcomes; Knee; Chondrocyte implantation; Prognosis; Stimulation; Sports medicine; Cartilage; Improvement; Autograft; Pain; Cohort study; Repair; Failure; Human; Edema; Swelling; Method; Algorithm; Case study; Symptomatology; Orthopedic surgery; Treatment; Follow up study; Debridment; Lesion; Comparative study
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546505275148

Background
Studies that compare the effectiveness of different cartilage repair treatments are needed to update treatment algorithms.
Hypothesis
Autologous chondrocyte implantation provides greater improvement in overall condition score than does debridement at a minimum of 3 years’ follow-up.
Study Design
Cohort study; Level of evidence, 3.
Methods
Cohorts for debridement and autologous chondrocyte implantation each included 58 Cartilage Repair Registry patients who met study criteria. A retrospective analysis was performed on prospectively collected baseline and follow-up data.
Results
Patients in the autologous chondrocyte implantation and debridement groups had similar demographics and chondral lesions at baseline. However, more autologous chondrocyte implantation patients failed a previous debridement or marrow stimulation procedure than did debridement patients. Follow-up outcome assessments were completed by 54 autologous chondrocyte implantation patients and 42 debridement patients. Eighty-one percent of the autologous chondrocyte implantation patients and 60% of the debridement patients reported median improvements of 5 points and 2 points, respectively, in the overall condition score. Autologous chondrocyte implantation patients also reported greater improvements in the median pain and swelling scores than did debridement patients. The treatment failure rate was the same for both autologous chondrocyte implantation and debridement patients. Eighteen autologous chondrocyte implantation patients and 1 debridement patient had at least 1 subsequent operation.
Conclusion
Although patients treated with debridement for symptomatic, large, focal, chondral defects of the distal femur had some functional improvement at follow-up, patients who received autologous chondrocyte implantations obtained higher levels of knee function and had greater relief from pain and swelling at 3 years.