Increased Failure Rate of Autologous Chondrocyte Implantation after Previous Treatment with Marrow Stimulation Techniques

Minas, Tom; Gomoll, Andreas H.; Rosenberger, Ralf; Royce, Ronald O.; Bryant, Tim

doi:10.1177/0363546508330137

Cited by 402 publications

(388 citation statements)

References 20 publications

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“…This may be related to damage to the subchondral bone. Minas et al 75 compared two cohorts of patients who had ACI-P, one group (111 patients) having had previous marrow stimulation procedures (MF, drilling or abrasion arthroplasty, all based on repair of the chondral defect by development of fibrocartilage from a blood clot) and the other (214) not. The groups were similar in age, duration and size of cartilage defect, duration of follow-up, concomitant procedures such as osteotomy or ligament repair, and size of repaired areas.…”

Section: Autologous Chondrocyte Implantation After Previous Microfracmentioning

confidence: 99%

“…Minas et al 75 also report a subgroup of 15 patients who had more than one chondral defect (35 defects in total) about half of which had been treated by marrow stimulation and half not, with all then receiving ACI. The failure rate was 2 out of 18 in the previously untreated lesions and 16 out of 17 of the previously treated ones.…”

Section: Autologous Chondrocyte Implantation After Previous Microfracmentioning

confidence: 99%

“…Failure was defined as requiring reoperation, somewhat stricter than in the Minas study. 75 One of the largest series of patients having ACI was reported by Nawaz et al from Stanmore: 80 1000 patients had ACI (519 with MACI, the rest ACI-C and some ACI-P) from 1998 to 2008. 80 In 827 patients with full follow-up data (mean follow-up 6.2 years), graft survival was 78% at 5 years and 51% at 10 years.…”

Section: Autologous Chondrocyte Implantation After Previous Microfracmentioning

confidence: 99%

“…The rest of the eligible patients would receive MF, though the reasons for not offering ACI are not explained. Based on data from three studies (Minas 2009, 75 Nawaz 2014, 80 Vijayan 2014 153 ) the manufacturers reasonably assumed that reoperations after MF do not have the same success rate as primary MACIs or ACIs. List prices were used for the costs for ACI (£18,300) and MACI (£16,226 excluding VAT).…”

Section: Cost-effectivenessmentioning

confidence: 99%

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

Mistry

Connock

Pink

et al. 2017

Health Technol Assess

213

164

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BackgroundThe surfaces of the bones in the knee are covered with articular cartilage, a rubber-like substance that is very smooth, allowing frictionless movement in the joint and acting as a shock absorber. The cells that form the cartilage are called chondrocytes. Natural cartilage is called hyaline cartilage. Articular cartilage has very little capacity for self-repair, so damage may be permanent. Various methods have been used to try to repair cartilage. Autologous chondrocyte implantation (ACI) involves laboratory culture of cartilage-producing cells from the knee and then implanting them into the chondral defect.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of ACI in chondral defects in the knee, compared with microfracture (MF).Data sourcesA broad search was done in MEDLINE, EMBASE, The Cochrane Library, NHS Economic Evaluation Database and Web of Science, for studies published since the last Health Technology Assessment review.Review methodsSystematic review of recent reviews, trials, long-term observational studies and economic evaluations of the use of ACI and MF for repairing symptomatic articular cartilage defects of the knee. A new economic model was constructed. Submissions from two manufacturers and the ACTIVE (Autologous Chondrocyte Transplantation/Implantation Versus Existing Treatment) trial group were reviewed. Survival analysis was based on long-term observational studies.ResultsFour randomised controlled trials (RCTs) published since the last appraisal provided evidence on the efficacy of ACI. The SUMMIT (Superiority of Matrix-induced autologous chondrocyte implant versus Microfracture for Treatment of symptomatic articular cartilage defects) trial compared matrix-applied chondrocyte implantation (MACI®) against MF. The TIG/ACT/01/2000 (TIG/ACT) trial compared ACI with characterised chondrocytes against MF. The ACTIVE trial compared several forms of ACI against standard treatments, mainly MF. In the SUMMIT trial, improvements in knee injury and osteoarthritis outcome scores (KOOSs), and the proportion of responders, were greater in the MACI group than in the MF group. In the TIG/ACT trial there was improvement in the KOOS at 60 months, but no difference between ACI and MF overall. Patients with onset of symptoms < 3 years’ duration did better with ACI. Results from ACTIVE have not yet been published. Survival analysis suggests that long-term results are better with ACI than with MF. Economic modelling suggested that ACI was cost-effective compared with MF across a range of scenarios.LimitationsThe main limitation is the lack of RCT data beyond 5 years of follow-up. A second is that the techniques of ACI are evolving, so long-term data come from trials using forms of ACI that are now superseded. In the modelling, we therefore assumed that durability of cartilage repair as seen in studies of older forms of ACI could be applied in modelling of newer forms. A third is that the high list prices of chondrocytes are reduced by confidential discounting. The main research needs are for longer-term follow-up and for trials of the next generation of ACI.ConclusionsThe evidence base for ACI has improved since the last appraisal by the National Institute for Health and Care Excellence. In most analyses, the incremental cost-effectiveness ratios for ACI compared with MF appear to be within a range usually considered acceptable. Research is needed into long-term results of new forms of ACI.Study registrationThis study is registered as PROSPERO CRD42014013083.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Autologous Chondrocyte Implantation After Previous Microfracmentioning

confidence: 99%

Section: Autologous Chondrocyte Implantation After Previous Microfracmentioning

confidence: 99%

Section: Autologous Chondrocyte Implantation After Previous Microfracmentioning

confidence: 99%

Section: Cost-effectivenessmentioning

confidence: 99%

See 2 more Smart Citations

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

Mistry

Connock

Pink

et al. 2017

Health Technol Assess

213

164

View full text Add to dashboard Cite

show abstract

“…Furthermore, the repair tissue with ACI may be no different than the fibrocartilage formed with microfracture [6]. ACI is expensive, requires two surgeries, and does not perform as well in patients with a previous history of microfracture [7]. Osteochondral autografts may also be used to treat large lesions; however, this procedure is limited by donor site morbidity.…”

Section: Introductionmentioning

confidence: 99%

Biologic Augmented Microdrilling Surgery for Multiple and Large Full-Thickness Cartilage Lesions in the Knee: Early Clinical and Radiological Results

Broyles¹,

O’Brien²,

Broyles³

et al. 2017

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Background: Various biologic treatments are available for articular cartilage lesions in the knee, but no one exists that is applicable to the full range of chondral disease and that is compliant with United States Food and Drug Administration regulations. The aim of this study was to evaluate outcomes following microdrilling surgery augmented with postoperative injections of bone marrow aspirate concentrate (BMAC), platelet rich plasma (PRP) and hyaluronic acid (HA). Methods: Eighteen patients with at least one symptomatic, full-thickness chondral lesion underwent arthroscopic microdrilling surgery. Immediately following surgery, patients received an intra-articular injection of fresh BMAC, PRP, and HA. This injection was repeated once per week for 5 consecutive weeks. At 4 and 12 months postoperatively, patients received 3 additional weekly injections for a total of 12 injections. Outcome Measures: IKDC (International Knee Documentation Committee) scores, KS (Knee Society) scores and plain radiographs. Results: The mean treated area was 6.2 ± 4.5 (range, 0.6 -14.7) cm 2 . The mean preoperative IKDC and KS scores (±SE) were 43.0 ± 3.2 and 68.3 ± 3.6 respectively. At 24 months postoperatively, IKDC and KS scores improved to 85.3 ± 4.2 and 94.7 ± 4.4, respectively; both changes from baseline were significant (p < 0.001). Radiographic analysis revealed that 9 of 18 patients in this series had joint space (JS) narrowing preoperatively. At 24 months, there was a 0.7 ± 0.3 mm overall increase in JS (p = 0.05). This change was greater in patients with preoperative JS < 2 mm, with an increase of 1.4 ± 0.5 mm (p for the difference between groups = 0.1). Conclusions: Microdrilling of cartilage lesions augmented with BMAC, PRP, and HA may be a viable treatment for a range of chondral disease with good early clinical and radiological results.

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Autologous chondrocyte implantation for full thickness articular cartilage defects of the knee

Vasiliadis

Wasiak

2010

Cochrane Database of Systematic Reviews

136

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Increased Failure Rate of Autologous Chondrocyte Implantation after Previous Treatment with Marrow Stimulation Techniques

Cited by 402 publications

References 20 publications

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

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

Biologic Augmented Microdrilling Surgery for Multiple and Large Full-Thickness Cartilage Lesions in the Knee: Early Clinical and Radiological Results

Autologous chondrocyte implantation for full thickness articular cartilage defects of the knee

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