Surgeon recommends autologous chondrocyte implantation for treatment of large knee lesions
GLASGOW — Autologous chondrocyte implantation outperformed mosaicplasty at 10 years for the treatment of symptomatic articular cartilage defects of the knee in younger patients, in a prospective, randomized comparison study conducted in the United Kingdom.
Leela C. Biant, BSc, AFRCS Ed, of the Royal National Orthopaedic Hospital Stanmore, presented the results at the 2010 Meeting of the Combined Orthopaedics Associations, here.
“ACI was significantly better,” Biant said. “We would not recommend mosaicplasty for large lesions or for salvage after other surgery. It is useful to remember that even ‘failures’ may not be failures in this group of patients if we can delay arthroplasty in the younger patient.
Study design
Biant and colleagues included 100 consecutive patients in their study with articular cartilage lesions that had been symptomatic for an average of 7.2 years. The average size of the defects following debridement was 4.66 cm2, and patients ranged in age from 16 to 49 years. All but six patients had undergone previous surgery for the defect.
Patients were randomized at arthroscopy if the lesion was suitable to undergo either of the two procedures: 58 patients were treated with autologous chondrocyte implantation (ACI) and 42 with mosaicplasty, according to Biant.
Failures, functional outcomes
Biant reported failures in 23 of 42 mosaicplasty patients and 10 of 58 ACI patients. “We defined failure as a clinically poor result with arthroscopic evidence of graft failure or revision surgery of any kind.”
Modified Cincinnati functional scores among the two groups were as follows: 28 ACI patients had excellent scores, compared to 4 mosaicplasty patients; seven ACI patients and five mosaicplasty patients had good scores; six ACI patients and four mosaicplasty patients had fair scores; and two patients from each group had poor scores. Biant noted that similar results were seen when using the Stanmore and Bentley functional rating systems.
“In conclusion, this is actually the largest long-term study of either method, and it is the longest comparative study,” Biant said. “This was surgery for chronic, large lesions which may not be the sportsman come straight off the pitch. So this is a very difficult-to-treat group in whom the alternative really is arthroplasty.”
Reference:
Biant L, et al. Autologous chondrocyte implantation versus mosaicplasty for symptomatic articular cartilage defects in the young adult knee: 10-year results of a prospective randomized comparison study. Presented at the 2010 Meeting of the Combined Orthopaedic Associations. Sept. 13-17. Glasgow.
It is a very interesting paper; previous works have been done by George Bentley’s group comparing ACI to mosaicplasty, showing that ACI is probably superior. Today they have presented longer term results still showing the same trend.
I think that this is a challenging group of patients to treat and these are large lesions. Overall, one might expect that a proportion of them might be in a more arthritic group rather than isolated defects, and so one might expect worse results. I think that multiple mosaicplasty plugs to treat large lesions may cause a problem at the donor site but also because the quality of repair will not be as good as you will find with smaller defects.
I think the lesson learned here is that mosaicplasty probably doesn’t have a roll in the large defect, and we’ll wait to see the results of ACI for treating this type of defect in larger series. Very interesting and some important messages, but more data is required. - — Andrew Price, PhD, FRCS(Orth), MBBChir, Session Moderator.
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