Autologous chondrocyte implantation versus debridement for treatment of full-thickness chondral defects of the knee: an observational cohort study with 3-year follow-up.
BACKGROUND
Studies that compare the effectiveness of different cartilage repair treatments are needed to update treatment algorithms.


OBJECTIVE
Autologous chondrocyte implantation provides greater improvement in overall condition score than does debridement at a minimum of 3 years' follow-up.


METHODS
Cohort study; Level of evidence, 3.


METHODS
Cohorts for debridement and autologous chondrocyte implantation each included 58 Cartilage Repair Registry patients who met study criteria. A retrospective analysis was performed on prospectively collected baseline and follow-up data.


RESULTS
Patients in the autologous chondrocyte implantation and debridement groups had similar demographics and chondral lesions at baseline. However, more autologous chondrocyte implantation patients failed a previous debridement or marrow stimulation procedure than did debridement patients. Follow-up outcome assessments were completed by 54 autologous chondrocyte implantation patients and 42 debridement patients. Eighty-one percent of the autologous chondrocyte implantation patients and 60% of the debridement patients reported median improvements of 5 points and 2 points, respectively, in the overall condition score. Autologous chondrocyte implantation patients also reported greater improvements in the median pain and swelling scores than did debridement patients. The treatment failure rate was the same for both autologous chondrocyte implantation and debridement patients. Eighteen autologous chondrocyte implantation patients and 1 debridement patient had at least 1 subsequent operation.


CONCLUSIONS
Although patients treated with debridement for symptomatic, large, focal, chondral defects of the distal femur had some functional improvement at follow-up, patients who received autologous chondrocyte implantations obtained higher levels of knee function and had greater relief from pain and swelling at 3 years.
Fu
Freddie H
FH
University of Pittsburgh Medical Center, Pennsylvania, USA.
Zurakowski
David
D
Browne
Jon E
JE
Mandelbaum
Bert
B
Erggelet
Christoph
C
Moseley
J Bruce
JB
Anderson
Allen F
AF
Micheli
Lyle J
LJ
D000328:Adult; D002358:Cartilage, Articular / Q000293:injuries* / Q000601:surgery; D019902:Chondrocytes / Q000637:transplantation*; D015331:Cohort Studies; D003646:Debridement; D005260:Female; D005269:Femur / Q000473:pathology; D006801:Humans; D007718:Knee Injuries / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010146:Pain; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome