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- Title
Differences in Clinical and Functional Outcomes Between Osteochondral Allograft Transplantation and Autologous Chondrocyte Implantation for the Treatment of Focal Articular Cartilage Defects.
- Authors
Matthews, John R.; Brutico, Joseph M.; Abraham, Daniel T.; Heard, Jeremy C.; Tucker, Bradford S.; Tjoumakaris, Fotios P.; Freedman, Kevin B.
- Abstract
Background: Articular cartilage pathology can result from a spectrum of origins, including trauma, osteochondritis dissecans, avascular necrosis, or degenerative joint disease. Purpose: To compare the differences in clinical and patient-reported outcomes after autologous chondrocyte implantation (ACI) versus osteochondral allograft transplantation (OCA) in patients with focal articular cartilage defects without underlying bone loss. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review identified patients who underwent ACI or OCA between 2008 and 2016 for isolated grades 3 and 4 articular cartilage defects without underlying bone loss. Outcome measures included the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), International Knee Documentation Committee (IKDC) evaluation, and 12-Item Short Form Health Survey–Physical Component (SF-12-P) scores. Defect location, size, complications, and rate of subsequent surgery were determined. Results: Overall, 148 patients were included: 82 (55%) underwent ACI and 66 (45%) underwent OCA. The mean age at the time of surgery was 31.2 years within the ACI cohort and 37.7 years within the OCA cohort (P <.001); the mean follow-up for both cohorts was 6.7 years (P =.902). Within the ACI group, 28 (34%) patients had multifocal defects, 21 (26%) had defects confined to the femoral condyles, and 33 (40%) had defects in the patellofemoral region. Within the OCA group, 23 (35%) patients had multifocal defects, 30 (46%) had confined femoral condyle lesions, and 13 (20%) had patellofemoral defects. When comparing by lesion location, there were no significant differences in KOOS JR, and IKDC scores between the ACI and OCA cohorts (P <.05). There was, however, a significant difference for SF-12-P scores for FDD trochlear lesions. In both cohorts, traumatic patellofemoral pathology demonstrated lower patient-reported outcomes and higher failure rates than degenerative lesions. The overall rate of failure, defined as graft failure with revision surgery and/or conversion to arthroplasty, was significantly greater in the OCA group (21% vs 4%; P =.002). Conclusion: Study results indicated that ACI provides similar outcomes to OCA with or without concomitant procedures for the treatment of symptomatic articular cartilage defects in all lesion locations and may have a lower revision rate for multifocal and condylar lesions.
- Subjects
CARTILAGE cell transplantation; HOMOGRAFTS; GRAFT rejection; ANALYSIS of variance; CARTILAGE diseases; HEALTH outcome assessment; RETROSPECTIVE studies; FISHER exact test; REGRESSION analysis; AUTOGRAFTS; TREATMENT effectiveness; T-test (Statistics); QUESTIONNAIRES; REOPERATION; DESCRIPTIVE statistics; CHI-squared test; ARTICULAR cartilage; DATA analysis software; LONGITUDINAL method
- Publication
Orthopaedic Journal of Sports Medicine, 2022, Vol 10, Issue 2, p1
- ISSN
2325-9671
- Publication type
Article
- DOI
10.1177/23259671211058425