Use of a type I/III bilayer collagen membrane decreases reoperation rates for symptomatic hypertrophy after autologous chondrocyte implantation.
BACKGROUND
Autologous chondrocyte implantation is associated with a high rate of reoperation, mostly due to hypertrophy of the periosteal patch. European studies investigating the use of collagen membranes as a periosteal substitute report significant decreases in reoperation rates to less than 5%. This multicenter study investigates the off-label use of 1 collagen membrane as a periosteal substitute for autologous chondrocyte implantation.


OBJECTIVE
The use of a collagen membrane for autologous chondrocyte implantation will decrease reoperation rates for hypertrophy with comparable rates of failure.


METHODS
Cohort study; Level of evidence, 3.


METHODS
A multicenter cohort of 300 patients treated with periosteal-covered autologous chondrocyte implantation was compared with a consecutive series of 101 patients who underwent collagen membrane-covered autologous chondrocyte implantation with the Bio-Gide membrane by the same group of surgeons. The 1-year hypertrophy-related reoperation rates and overall failure rates of autologous chondrocyte implantation were evaluated in both groups.


RESULTS
Both groups were comparable for age (periosteal autologous chondrocyte implantation, 31.9 years; collagen autologous chondrocyte implantation, 32.4 years; P = .8) and average defect size (4.6 cm(2) and 4.7 cm(2), respectively; P = .7). The average number of defects (1.5 and 1.8; P = .001) and total defect area per knee (6.7 cm(2) and 8.6 cm(2); P = .003) were larger in the collagen membrane group. Within 1 year of surgery, 25.7% of patients treated with periosteal-covered autologous chondrocyte implantation required reoperation for hypertrophy and 2.3% were considered to have failed their treatment with autologous chondrocyte implantation. In comparison, only 5% of patients required reoperation for hypertrophy after collagen membrane-covered autologous chondrocyte implantation, and 4% were considered treatment failures.


CONCLUSIONS
The use of a collagen membrane for autologous chondrocyte implantation decreased the reoperation rate for hypertrophy after autologous chondrocyte implantation from 25.7% to 5% (P < .0001). Overall 1-year failure rates were comparable between the groups (P = .2). Even though the use of a collagen membrane for autologous chondrocyte implantation constitutes an off-label indication, its application appears justified by the lower morbidity to patients and decreased cost to the health care system. A detailed discussion with the patient is required regarding the use of an off-label device.
Gomoll
Andreas H
AH
Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 850 Boylston Street, Chestnut Hill, MA 02467, USA. agomoll@yahoo.com
Probst
Christian
C
Farr
Jack
J
Cole
Brian J
BJ
Minas
Tom
T
D000293:Adolescent; D000328:Adult; D019902:Chondrocytes / Q000637:transplantation*; D015331:Cohort Studies; D024042:Collagen Type I / Q000627:therapeutic use*; D024061:Collagen Type III / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection; D006801:Humans; D006984:Hypertrophy / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D014182:Transplantation, Autologous; D055815:Young Adult
D024042:Collagen Type I; D024061:Collagen Type III