Reoperation after autologous chondrocyte implantation. Indications and findings.
We have reviewed 22 patients from a total of 135 treated by autologous chondrocyte implantation (ACI) who had undergone further surgery for pain in the knee and mechanical symptoms after a mean of 10.5 months. There were 31 grafted lesions. At operation the findings included lifting (24/31) and detachment (3/31) of periosteal patches for which arthroscopic shaving was performed. Chondroplasty was undertaken on two new lesions, another required an ACI and a further patient required trimming of a meniscus. The mechanical symptoms resolved within two weeks. At the last review, two to 14 months from reoperation; 68% had improved, and 86% had normal or nearly normal IKDC scores. Of the 31 lesions, 30 (97%) had normal or nearly normal visual repair scores. Biopsy showed good integration with subchondral bone and the marginal interface in all specimens, most of which showed hyaline or hyaline-like cartilage (70%). Troublesome mechanical symptoms required surgery in 13% of ACI-treated patients and were attributed to periosteal extrusion. Simple arthroscopic debridement was curative.
Henderson
I
I
Orthopaedic Research Department, St Vincent's and Mercy Private Hospital, East Melbourne, Victoria, Australia.
Tuy
B
B
Oakes
B
B
D000328:Adult; D018771:Arthralgia / Q000209:etiology / Q000601:surgery; D001706:Biopsy / Q000379:methods; D002357:Cartilage Diseases / Q000601:surgery*; D002358:Cartilage, Articular / Q000637:transplantation; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D014182:Transplantation, Autologous; D016896:Treatment Outcome