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Higher failure rate seen in ACI cases with prior marrow stimulation
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SAN FRANCISCO — The results of a new study presented here indicate more than a three-fold failure rate after performing autologous chondrocyte implantation in cases previously treated with marrow stimulation techniques compared to cases that have not undergone such procedures.
In a prospective review of 325 knees in 321 patients, Tom Minas, MD, and colleagues compared the results of those who underwent autologous chondrocyte implantation (ACI) either after a prior marrow stimulation technique or no prior marrow stimulation.
Minas presented the results at the American Orthopaedic Society for Sports Medicine Specialty Day Meeting.
While the investigators found similar preoperative characteristics for both groups, they discovered more than a three-fold increase in the overall failure rate among patients treated with prior marrow stimulation. Moreover, the three-to-one failure rate between the marrow stimulation and control groups remained regardless of disease severity, workman's compensation status and the type of prior marrow stimulation technique. The investigators also found no difference between drilling, abrasion and microfracture.
"We feel that this is a safety not an efficacy study for ACI after a marrow stimulation technique," Minas said during his presentation.
"We feel that marrow stimulation does burn bridges and should not be used for large defects, such as 5 cm². We recommend marrow stimulation for those situations that have been recognized in the literature — small defects less than 2 cm²," he said.
The study included more than 2 years follow-up on 214 knees with prior marrow stimulation and 111 control knees. Patients had an average of 1.8 lesions with a transplanted area of nearly 5 cm² per lesion.
For more information:
- Gomoll A, Rosenberger R, Bryant T, et al. Marrow stimulation techniques increase the failure rate of subsequent autologous chondrocyte implantation. Presented at the American Orthopaedic Society for Sports Medicine Specialty Day Meeting. March 8, 2008. San Francisco.