title: Evidence of inappropriate application of autologous cartilage transplantation therapy in an uncontrolled environment.
abstract: Autologous chondrocyte transplantation is a new procedure developed for the treatment of focal articular cartilage defects of the knee. The exact indications and limitations of this procedure have not yet been completely defined through prospective, randomized studies. The purpose of this study was to examine the indications and contraindications for surgery in consecutive cases initially rejected for reimbursement of surgical expenses by insurance companies, but now on appeal, to assess whether patients referred by the physicians met the procedure criteria. Twenty-four consecutive candidates were referred for adjudication when the recommending orthopaedic surgeon appealed a rejection by a medical reviewer. The factors examined included the number and size of the cartilage lesions, the presence of tricompartmental arthritis, transplantation proposed for patellar lesions, patient age, and sagittal plane deformity. In 23 of 24 cases (96%) the indications for the procedure were not met or specific contraindications were present. In 15 of 24 cases (63%) there were multiple contraindications. The results of this study underscore the importance of controlled, application-limited experience before the release of new procedures for widespread clinical applications. The uncontrolled use of this procedure may negatively skew the overall results for this technique, prejudicing a procedure that may be successful for the correct indications.
authors.affiliation: Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, The Good Samaritan Hospital, Baltimore, Maryland, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Mont
authors.forename: L C
authors.initials: LC
authors.lastname: Jones
authors.forename: B N
authors.initials: BN
authors.lastname: Vogelstein
authors.forename: D S
authors.initials: DS
authors.lastname: Hungerford
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001168:Arthritis / Q000601:surgery; D002357:Cartilage Diseases / Q000601:surgery*; D002358:Cartilage, Articular / Q000601:surgery*; D019902:Chondrocytes / Q000637:transplantation*; D000075202:Contraindications; D004059:Diffusion of Innovation; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D007592:Joint Diseases / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010329:Patella / Q000601:surgery; D018579:Patient Selection; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014600:Utilization Review