Document Detail

Repair of large chondral defects of the knee with autologous chondrocyte implantation in patients 45 years or older.
MedLine Citation:
PMID:  18725654     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Autologous chondrocyte implantation (ACI) has become an accepted option for the treatment of chondral defects in carefully selected patients. Current recommendations limit this procedure to younger patients, as insufficient data are available to conclusively evaluate outcomes in patients older than 45 years. HYPOTHESIS: Cartilage repair with ACI in patients older than 45 years results in substantially different outcomes than those previously reported for younger age groups. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This prospective cohort study reviewed patients > or =45 years of age at the time of treatment with ACI. The clinical evaluation included a patient satisfaction questionnaire and four validated rating scales: Short Form-36, Modified Cincinnati Rating Scale, WOMAC (Western Ontario and McMaster Universities) Osteoarthritis Index, and the Knee Society Score. RESULTS: A total of 56 patients > or =45 years of age were treated with ACI. The average patient age at index surgery was 48.6 years (range, 45-60 years). The minimum follow-up was 2 years (range, 2-11 years; mean, 4.7 years). The cohort included 36 men and 20 women. The mean transplant size was 4.7 cm(2) per defect (range, 1-15.0 cm(2)) and 9.8 cm(2) per knee (range, 2.5-31.6 cm(2)). Twenty-eight patients (50%) underwent concomitant osteotomies to address malalignment. There were 8 failures (14%): 6 of 15 (40%) in patients receiving workers' compensation (WC) and 2 of 41 (4.9%) in non-WC patients. Additional arthroscopic surgical procedures were required in 24 patients (43%) for periosteal-related problems and adhesions; 88% of these patients experienced lasting improvement. At their latest available follow-up, 72% of patients rated themselves as good or excellent, 78% felt improved, and 81% would again choose ACI as a treatment option. CONCLUSION: Our results showed a failure rate of ACI in older patients that is comparable with rates reported in younger patient groups. The procedure is associated with a substantial rate of reoperations, mostly for the arthroscopic treatment of graft hypertrophy, similar to that in younger patients.
Ralf E Rosenberger; Andreas H Gomoll; Tim Bryant; Tom Minas
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-08-25
Journal Detail:
Title:  The American journal of sports medicine     Volume:  36     ISSN:  1552-3365     ISO Abbreviation:  Am J Sports Med     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-16     Completed Date:  2009-03-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7609541     Medline TA:  Am J Sports Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2336-44     Citation Subset:  IM    
Cartilage Repair Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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MeSH Terms
Age Factors
Cartilage Diseases / surgery*
Chondrocytes / transplantation*
Knee Injuries / surgery*
Middle Aged
Prospective Studies
Recovery of Function
Transplantation, Autologous
Treatment Outcome

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