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A third of soldiers disabled after ACI for lesions in the knee
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Autologous chondrocyte implantation performed in the knee for articular cartilage restoration after injury is less successful in active duty military populations compared to civilians, according to recently presented research.
“In young, athletic civilians we do see good long-term results. However, in our series, only 33% of our soldiers were still on active duty, and an additional 33% were considered officially disabled,” Jeanne Patzkowski, MD, of the San Antonio Military Medical Center at Fort Sam in Houston, said.
“The remaining 67% had either undergone medical discharge or had finished their initial service obligation and left the military.” Of the 57 active duty solders included in the retrospective, multicenter, IRB-approved study, 18 soldiers were found unfit for duty with most disability linked to loss of range of motion in the knee and degenerative knee arthritis.
Extreme physical demands
Although autologous chondrocyte implantation (ACI) is associated with high satisfaction rates, return to high-demand activity, and sustained radiographic and clinical improvement in civilian athletes, it does not appear to offer the same benefits to military patients. “Our military patients are subject to daily unique physical demands, austere environments and uniform requirements, and it remains to be seen whether these same outcomes would hold up in our population,” said Patzkowski.
She and her colleagues studied soldiers in the Army who had undergone ACI for full thickness lesions in the knee during a 7-year period. Among the cohort, patients presented with 75 lesions measuring an average size of 4 cm2 size. Patients had an average age of 33 years at the time of the procedure and most were male.
Fourteen patients presented with multifocal lesions, which were individually treated during the same ACI procedure, and 29 patients underwent a concomitant osteotomy at the time of ACI.
Common medical reason for leave
Articular cartilage lesions are diagnosed in up to 100,000 civilian athletes yearly, and are linked to decreased quality of life and ability to participate in sports as well as potential linkage to end-stage arthritis. Similarly, Patzkowski noted that the disease is one of the most common medical reasons military personnel exit from service.
She said additional research is needed to pinpoint the best course of treatment for patients on active duty with full-thickness cartilage lesions. Study limitations include the size of the study, inclusion of concomitant procedures, large number of multifocal lesions and an inability of the researchers to account for mitigating factors in soldiers’ decisions to leave the military. – by Katie Pfaff
Reference:
Patzkowski J. Paper SS-56. Presented at: Arthroscopy Association of North America Annual Meeting; May 1-3, 2014; Hollywood, Fla.
For more information:
Jeanne Patzkowski, MD, can be reached at San Antonio Military Medical Center, 3851 Roger Brooke Dr., Fort Sam Houston, TX 78234; email: jeanne.patzkowski@us.army.mil.
Disclosure: Patzkowski has no relevant financial disclosures.