Sage Journals: Discover world-class research

Abstract

Background:

This is an analysis of the prospective Study of the Treatment of Articular Repair (STAR) to evaluate the effectiveness of autologous chondrocyte implantation (ACI) in a subset of adult patients with osteochondritis dissecans (OCD) knee lesions.

Hypothesis:

Autologous chondrocyte implantation can improve clinical outcomes in patients with at least 1 chronic OCD lesion of the knee who failed a previous non-ACI cartilage repair treatment.

Study Design:

Case series; Level of evidence, 4.

Methods:

Forty patients with at least one failed non-ACI treatment for an OCD knee lesion received ACI in a multicenter study. The modified Cincinnati Knee Rating System, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Short-Form 36 Health Survey (SF-36) were used to assess patient outcomes at baseline and periodically to 48 months. Treatment failures, serious adverse events, and subsequent surgical procedures were recorded.

Results:

Thirty-two (80%) patients completed the 48-month study. Autologous chondrocyte implantation treatment was successful in 85% of patients. Mean (± standard deviation) overall knee condition score (modified Cincinnati) was 3.1 ± 1.1 at baseline and 6.8 ± 2.0 at month 48. Clinically and statistically significant (P < .001) mean improvements from baseline to month 48 for the KOOS were as follows: 51.5 to 79.5 (pain), 54.8 to 77.9 (symptoms), 27.5 to 63.6 (sports and recreation ability), 63.5 to 86.7 (activities of daily living), and 21.9 to 59.6 (knee-related quality of life). The mean improvement (P < .001) in overall health assessed by the SF-36 was 35.4 to 45.5. Thirty-five percent (n = 14/40) of patients had a subsequent surgical procedure, most frequently debridement of the cartilage lesion. Treatment failure occurred in 6 of 32 (19%) patients.

Conclusion:

Patients with OCD of the knee had statistically significant pain reduction and functional improvement for up to 48 months after ACI, despite the complexity and severity of the osteochondral lesions.

Keywords

articular cartilage repair autologous chondrocyte implantation (ACI)Carticel osteochondritis dissecans (OCD)

Get full access to this article

View all access options for this article.

References

Bentley

Biant

Carrington

. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. 2003;85:223-230.

Blevins

Steadman

Rodrigo

Silliman

. Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. Orthopedics. 1998;21:761-767.

Brittberg

Lindahl

Nilsson

Ohlsson

Isaksson

Peterson

. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994;331:889-895.

Browne

Anderson

Arciero

. Clinical outcome of autologous chondrocyte implantation at 5 years in US subjects. Clin Orthop Relat Res. 2005;436:237-245.

Cahill

. Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Am Acad Orthop Surg. 1995;3:237-247.

Cahill

Phillips

Navarro

. The results of conservative management of juvenile osteochondritis dissecans using joint scintigraphy. Am J Sports Med. 1989;17:601-606.

Cole

D’Amato

. Autologous chondrocyte implantation. Oper Tech Orthop. 2001;11:115-131.

Detterline

Goldstein

Rue

Bach

Jr . Evaluation and treatment of osteochondritis dissecans lesions of the knee. J Knee Surg. 2008;21:106-115.

Fonseca

Balaco

. Fixation with autogenous osteochondral grafts for the treatment of osteochondritis dissecans (stages III and IV). Int Orthop. 2009;33:139-144.

10.

Zurakowski

Browne

. Autologous chondrocyte implantation versus debridement for treatment of full-thickness chondral defects of the knee: an observational cohort study with 3-year follow-up. Am J Sports Med. 2005;33:1658-1666.

11.

Kish

Modis

Hangody

. Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete: rationale, indications, techniques, and results. Clin Sports Med. 1999;18:45-66, vi.

12.

Kocher

Micheli

Yaniv

Zurakowski

Ames

Adrignolo

. Functional and radiographic outcome of juvenile osteochondritis dissecans of the knee treated with transarticular arthroscopic drilling. Am J Sports Med. 2001;29:562-566.

13.

Kocher

Tucker

Ganley

Flynn

. Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med. 2006;34:1181-1191.

14.

McCarty

. Primary repair of osteochondritis dissecans in the knee. In: Cole

Sekiya

, ed. Surgical Techniques of the Shoulder, Elbow, and Knee in Sports Medicine. Philadelphia: Saunders Elsevier; 2008:517-526.

15.

Micheli

Browne

Erggelet

. Autologous chondrocyte implantation of the knee: multicenter experience and minimum 3-year follow-up. Clin J Sport Med. 2001;11:223-228.

16.

Micheli

Moseley

Anderson

. Articular cartilage defects of the distal femur in children and adolescents: treatment with autologous chondrocyte implantation. J Pediatr Orthop. 2006;26:455-460.

17.

Millington

Shah

Dahm

Levy

Stuart

. Bioabsorbable fixation of unstable osteochondritis dissecans lesions. Am J Sports Med. 2010;38:2065-2070.

18.

Minas

. Autologous chondrocyte implantation for focal chondral defects of the knee. Clin Orthop Relat Res. 2001;391(Suppl):S349-S361.

19.

Mintzer

Richmond

Taylor

. Meniscal repair in the young athlete. Am J Sports Med. 1998;26:630-633.

20.

Mithofer

Minas

Peterson

Yeon

Micheli

. Functional outcome of knee articular cartilage repair in adolescent athletes. Am J Sports Med. 2005;33:1147-1153.

21.

Moriya

Wada

Watanabe

. Evaluation of reparative cartilage after autologous chondrocyte implantation for osteochondritis dissecans: histology, biochemistry, and MR imaging. J Orthop Sci. 2007;12:265-273.

22.

Noyes

Barber

Mooar

. A rationale for assessing sports activity levels and limitations in knee disorders. Clin Orthop Relat Res. 1989;246:238-249.

23.

Ossendorf

Steinwachs

Kreuz

. Autologous chondrocyte implantation (ACI) for the treatment of large and complex cartilage lesions of the knee. Sports Med Arthrosc Rehabil Ther Technol. 2011;3:11.

24.

Outerbridge

. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43:752-757.

25.

Pascual-Garrido

Friel

Kirk

. Midterm results of surgical treatment for adult osteochondritis dissecans of the knee. Am J Sports Med. 2009;37(Suppl 1):125S-130S.

26.

Peterson

Brittberg

Kiviranta

Akerlund

Lindahl

. Autologous chondrocyte transplantation: biomechanics and long-term durability. Am J Sports Med. 2002;30:2-12.

27.

Peterson

Minas

Brittberg

Lindahl

. Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg Am. 2003;85(Suppl 2):17-24.

28.

Peterson

Minas

Brittberg

Nilsson

Sjogren-Jansson

Lindahl

. Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res. 2000;374:212-234.

29.

Roberts

McCall

Darby

. Autologous chondrocyte implantation for cartilage repair: monitoring its success by magnetic resonance imaging and histology. Arthritis Res Ther. 2003;5:R60-R73.

30.

Roberts

Menage

Sandell

Evans

Richardson

. Immunohistochemical study of collagen types I and II and procollagen IIA in human cartilage repair tissue following autologous chondrocyte implantation. Knee. 2009;16:398-404.

31.

Roos

Lohmander

Ekdahl

Beynnon

. Knee Injury and Osteoarthritis Outcome Score (KOOS): development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28:88-96.

32.

Stattin

Wiklund

Lindblom

. A missense mutation in the aggrecan C-type lectin domain disrupts extracellular matrix interactions and causes dominant familial osteochondritis dissecans. Am J Hum Genet. 2010;86:126-137.

33.

Uematsu

Habata

Hasegawa

. Osteochondritis dissecans of the knee: long-term results of excision of the osteochondral fragment. Knee. 2005;12:205-208.

34.

Van Demark

. Osteochondritis dessecans with spontaneous healing. J Bone Joint Surg Am. 1952;34:143-148.

35.

Vasiliadis

Danielson

Ljungberg

McKeon

Lindahl

Peterson

. Autologous chondrocyte implantation in cartilage lesions of the knee: long-term evaluation with magnetic resonance imaging and delayed gadolinium-enhanced magnetic resonance imaging technique. Am J Sports Med. 2010;38(5):943-949.

36.

Ware

Snow

Kosinski

. SF-36 Health Survey: Manual & Interpretation Guide. Boston: The Health Institute; 1997.

37.

Weckstrom

Parviainen

Kiuru

Mattila

Pihlajamaki

. Comparison of bioabsorbable pins and nails in the fixation of adult osteochondritis dissecans fragments of the knee: an outcome of 30 knees. Am J Sports Med. 2007;35:1467-1476.

38.

Zaslav

Cole

Brewster

. A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: results of the Study of the Treatment of Articular Repair (STAR) clinical trial. Am J Sports Med. 2009;37:42-55.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB

Outcomes of Autologous Chondrocyte Implantation in Study of the Treatment of Articular Repair (STAR) Patients With Osteochondritis Dissecans

Abstract

Background:

Hypothesis:

Study Design:

Methods:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material