Factors Influencing the Outcome of Autologous Chondrocyte Implantation: A Systematic Review

Abstract

Autologous chondrocyte implantation (ACI) is an effective method of treatment of chondral defects of the knee. ACI outcomes are influenced by patient-, knee-, and lesion-specific factors. We compiled subject-level data from current studies on ACI and quantitatively analyzed this data set for associations between patient-, knee-, and lesion-specific factors and the outcome of ACI surgery. A systematic review of studies investigating ACI treatment outcomes in the knee was performed. Only studies that published subject-level data were included. Data on patient and lesion characteristics, as well as clinical outcome scores, were collected. Thirteen studies (305 defects) were included in this review. These studies showed that ACI treatment improves clinical outcomes in different patient populations. However, subject-specific variables such as patient age, gender, body mass index, duration of preoperative symptoms, as well as defect size and location were not associated with International Knee Documentation Committee score or visual analog scale score changes (p > 0.05 for all). Covariate analysis showed that patient age was related to symptom duration prior to surgery (p = 0.009). ACI surgery has been shown to improve outcomes in patients with chondral lesions of the knee. Despite evidence in the literature showing that multiple patient-, knee-, and lesion-specific factors may influence treatment outcomes, our review shows that these factors, solely, do not affect outcomes. However, together, they may synergistically affect outcomes.

Autologous chondrocyte implantation in the knee: systematic review and economic evaluation

“…Behery et al 83 reviewed 12 case series with 270 knees and found that none of age, gender, duration of symptoms and lesion size significantly predicted outcomes. They noted successful use of ACI in patients aged over 50 years in three studies.…”

Osteochondritis Dissecans of the Knee

“…As with other cartilage repair techniques, younger patients with more localized lesions tend to do better [118][119][120].…”

Functional Outcomes After Surgical Management of Articular Cartilage Lesions in the Knee: A Systematic Literature Review to Guide Postoperative Rehabilitation

“…Throughout the rehabilitation program, promotion of proper muscle activation, joint mechanics, and technique with minimal compensation patterns during all exercises and activities is likely important to optimize muscle performance and normalize joint-loading strategies following articular cartilage procedures in the knee. 5,8,28 and therefore were not a focus of our search. To the best of our knowledge, this is the first systematic review to evaluate functional performance following cartilage procedures.…”

“…[ research report ] capacity during activities of daily living (eg, 6-minute walk test) or to evaluate performance during higher levels of activity (eg, single-leg hop tests). Outcomes following articular cartilage surgical procedures related only to patient-reported outcome measures have been summarized in previous reviews 5,8,28 and therefore were not a focus of our search. To the best of our knowledge, this is the first systematic review to evaluate functional performance following cartilage procedures.…”

“…Studies that included only patient-reported outcome measures were not included in our review; however, these studies are nicely included in the systematic reviews by Harris et al, 28 Behery et al, 5 and Chalmers et al 8 To the best of our knowledge, this is the first systematic review to evaluate functional performance following cartilage procedures.…”