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Thursday, March 11, 2004

Autologous chondrocyte implantation effective

Procedures aimed at biologically repairing cartilage injuries may have the greatest potential benefit in young patients due to their life expectancy and functional demands. Most cartilage procedure outcome studies, however, focus on older patient populations.

According to researchers presenting Scientific Paper 22 on Wednesday, autologous chondrocyte implantation (ACI) may be an effective option for treatment of large chondral lesions in juvenile patients (less than 18 years of age).

The prospective, multicenter, observation study examined outcomes of patients who were implanted with cultured autologous chondrocytes. Included were 39 patients who met the following criteria:

Information on adverse events and subsuquent operations were captured. Treatment outcomes were measured using the 10-point modified Cinncinnati Knee Rating System.

Mean age of patients was 16 years; approximately 60 percent were male. Twenty-four patients underwent at least one cartilage repair procedure prior to cartilage harvest, including 12 who had a marrow stimulation procedure. Fourteen patients were diagnosed with osteochondritis dissecans (OCD) lesions. Thirty-five patients had single defects, mean size: 5.3 cm2.

Thirty-two patients completed self-evaluations at a minimum of two years after implantation (mean follow-up = 4.2 years). For these patients, the mean overall condition score improved at least one point from baseline to follow-up (p < 0.0001) and 4.4 points for 29 patients who improved at least one point from baseline to follow-up (p < 0.0001).

Pain and swelling scores improved 4.2 (p < 0.0001) and 3.6 points (p < 0.0001), respectively. There were no treatment failures at follow-up.

The authors believe that this study supports the treatment of clinically significant chondral injuries in children or adolescents with autologous cartilage implants. "The favorable outcome of these interventions is certainly encouraging but note is made of the fact that this is a two-year follow-up and much longer follow-up of this cohort is necessary before any certain conclusions can be drawn regarding the efficacy of this or other such intervention in this age group," stated lead researcher Lyle J. Micheli, MD, of Boston.

In addition to Dr. Michali, study authors included Bruce Moseley, MD, of Houston; Allen F. Anderson, MD, of Nashville, Tenn.; Jon E. Browne, MD, of Kansas City, Mo.; Christoph Erggelet, MD, of Freiburg, Germany; Robert A. Arciero, MD, of Farmington, Conn.; Freddie H. Fu, MD, of Pittsburgh; and Bert Mandelbaum, MD, of Santa Monica, Calif.

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Last modified 20/February/2004