Long-Term Durability of Autologous Chondrocyte Implantation

Abstract

Background: Autologous chondrocyte implantation for full-thickness lesions of the distal femur has demonstrated good short- to midterm clinical improvement. However, long-term durability (>5 years) of autologous chondrocyte implantation has not been evaluated in US patients to date.

Hypothesis: Patients who improve from baseline to early follow-up will sustain improvement at later follow-up.

Study Design: Case series, Level of evidence, 4.

Methods: Cartilage Repair Registry patients with full-thickness distal femur lesions who were treated with autologous chondrocyte implantation before December 31, 1996 and had modified overall Cincinnati scores at baseline and 1- to 5-year follow-up scores were re-evaluated at 6- to 10-year follow-up. Autologous chondrocyte implantation durability was determined by comparing early (1-5 years) to long-term (6-10 years) outcomes. Adverse events and treatment failures were recorded.

Results: Seventy-two patients met eligibility criteria (at baseline: mean age, 37 years; mean lesion size, 5.2 cm2; and overall condition score, 3.4 points [poor]). Eighty-seven percent of patients (47 of 54) who improved at the earlier follow-up period sustained a mean improvement in overall condition score of 3.8 points from baseline to the later follow-up period (P < .001). From baseline to 10-year follow-up (mean follow-up, 9.2 years), 69% improved, 17% failed, and 12.5% reported no change from baseline. Most failures (75% [9 of 12]) occurred at a mean follow-up of 2.5 years. Thirty patients (42%) had 42 operations after autologous chondrocyte implantation; 24 operations (57%) occurred in patients who met the study definition of failure.

Conclusion: Treatment with autologous chondrocyte implantation for large, symptomatic, full-thickness lesions of the distal femur can result in early improvement that is sustained at longer follow-up (up to 10 years) in the majority of patients.