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Having a workers' compensation claim and multiple defects may impact outcomes after autologous chondrocyte implantation

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WASHINGTON — Research presented here suggests that autologous chondrocyte implantation offers durable functional improvement and symptomatic relief. In addition, the researchers identified factors that may influence postoperative outcomes.

Brian J. Cole, MD, MBA, of Rush University Medical Center in Chicago, and his colleagues prospectively studied 137 patients that he treated with autologous chondrocyte implantation (ACI) using the Carticel procedure (Genzyme Biosurgery) with a minimum 2-year follow-up. They discovered statistically significant differences from preop to final postoperative scores on the Lysholm, Tegner, International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Scales (KOOS), Noyes and SF-12 scales and found that 75% of the patients were completely or mostly satisfied with the procedure.

The investigators also found an overall reoperation rate of about 30%, but believed that 16% of the reoperations were related to the ACI procedure.

Likewise, they found no significant differences in outcomes based on defect location or whether the procedure performed prior to the ACI was a marrow stimulation or debridement. However, they discovered that patients who had multiple defects had significantly lower KOOS quality of life and IKDC scores compared to single-defect patients.

The investigators noted that patients with work-related injuries had lower scores on nearly every outcome measure compared to those with non-work-related injuries.

"This is a relatively large cohort of patients in a single center with greater than 4-year follow-up," Cole said during his presentation at the 27th Annual Meeting of the Arthroscopy Association of North America. "The results have proven to be durable and maintain symptomatic improvement. Multiple defects, rather than defect location, seemed to negatively affect our outcome, as did the fact that these patients had a workers' compensation claim."

Cole is a consultant to Genzyme.

For more information:

• Cole BJ, Mc Nickle AG, L'Heureux DR, et al. Autologous chondrocyte implantation: Functional and symptomatic outcomes beyond two years. Paper #SS-18. Presented at the 27th Annual Meeting of the Arthroscopy Association of North America. April 24-27, 2008. Washington.