Survival Rates of Various Autologous Chondrocyte Grafts and Concomitant Procedures. A Prospective Single-Center Study over 18 Years

Abstract

Seven different autologous chondrocyte implantation (ACI) grafts were used consecutively over a period of 18 years for the treatment of cartilage lesions in the knees. The aim was to evaluate this entire ACI patient series for graft-related or unrelated serious adverse events (SAE), graft failures, and to reveal potential risk factors for these incidents. The study group comprised 151 operated patients: classical periosteum-ACI (n = 45); ACI-seeded fibrin-collagen patch, fixed by either periosteum (n = 59), collagen membrane (n = 15), or fibrin glue (n = 6); ACI seeded alginate-agarose hydrogel (n = 14); and biomimetic collagen-hydroxyapatite scaffold injected with the ACI suspension (n = 12). The covariates analyzed as possible predicting factors were: age, gender, BMI, lesion depth, lesion size, lesion location, previous surgeries, and concomitant procedures. The Kaplan–Meier method for estimating survival curves, and Cox’s proportional hazards model to test for covariates, were used in the statistical analysis. The patients in this series, follow-up 10.1 (2.1–18.3) years, encountered 11% of graft-related SAE (risk factors: previous cartilage surgery, age over 40 years, BMI over 25 kg/m2, and meniscus surgery) and 10% of graft unrelated SAE (risk factors: meniscus surgery and osteotomy). None of these factors was a risk for definitive graft failure. The 10-year graft survival rate was 86%. Females had 2.8 times higher incidence of graft failures than males. There was a tendency toward higher graft failures after a previous cartilage surgery. Different ACI graft types offered safe and durable cartilage repair. Female gender, age over 40 years, increased weight, previous cartilage surgery, and meniscus loss showed increased risk for revision surgery or graft failures.

Long-term Results of Arthroscopic Matrix-Assisted Autologous Chondrocyte Transplantation: A Prospective Follow-up at 15 Years

“…In fact, different failure rates were documented in this series, with female patients and patients affected by degenerative lesions being more at risk. This confirms previous literature 13,14,21 supporting the negative influence of a degenerative joint environment on the survival of MACT, 3,8 as well as the poorer outcome often documented in women. This is a controversial aspect.…”

“…Many studies have documented overall good findings for these regenerative strategies to address lesions of the articular surface, and after >20 years from their introduction in clinical practice, long-term reports about first-generation ACI are being published, documenting durability of the results. 6,21,26,30 Several studies have presented data with >12 years of follow-up, reporting long-lasting clinical improvement, with a failure rate ranging from 25% to 37% at long-term follow-up. 6,24,26 Long-term evaluation is particularly important for these treatments, since patients undergoing surgery are often young and focused on recovering and maintaining an active lifestyle.…”

Prior Bone Marrow Stimulation Surgery Influences Outcomes After Cell-Based Cartilage Restoration: A Systematic Review and Meta-analysis

“…Ogura et al 27 demonstrated this phenomenon in a study on revision ACI in which their analysis demonstrated failure rates of 30% to 50% at 5-and 10-year follow-up for revision ACI, which is inferior to that seen in primary ACI. 2,5,19 This has also been seen for other cartilage procedures in the knee, such as osteochondral allograft. 14 Given that ACI after a prior BMS represents a revision scenario, it is not surprising that the results of this paper demonstrated a similar trend to other revision cartilage restoration techniques, which suggests that a revision setting alone may contribute to increased failure rates.…”

“…Patient-specific factors include increased age, female sex, and WC status. 19,30,33 Lesion-specific factors include complexity of lesion, history of prior surgeries of the affected joint, first-generation ACI technique, lesion size >4.5 cm 2 , and the failure to perform concomitant tibial tubercle osteotomy when indicated. 15,21,28,30 These risk factors have been described elsewhere in the literature, and given the heterogeneity of data reporting in the included studies, we could not adjust for all these factors in our review.…”

Clinical and Quality of Life Outcomes of a Combined Synthetic Scaffold and Autogenous Tissue Graft Procedure for Articular Cartilage Repair in the Knee

“…However, most patients (70% of cases) have combined lesions, or "red knees" [17,18]. Martinčič et al [19] followed 151 patients for an average of 10 years after knee cartilage repair. They found no statistically signi cant difference in outcomes between patients with and without a history of prior surgery.…”