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Andreas H. Gomoll - One of the best experts on this subject based on the ideXlab platform.

  • prior surgery negatively affects cell culture identity in patients undergoing autologous Chondrocyte Implantation
    American Journal of Sports Medicine, 2020
    Co-Authors: Alexandre Barbieri Mestriner, Jakob Ackermann, Courtney Vanarsdale, Andreas H. Gomoll
    Abstract:

    Background:Recently, a cell identity assay has been introduced to evaluate the identity of cultured Chondrocytes before autologous Chondrocyte Implantation (ACI), which was shown to be associated w...

  • Demographics in Patients Receiving Matrix-Assisted Chondrocyte Implantation (MACI) in the Ankle:
    Cartilage, 2019
    Co-Authors: Kris Chadwick Hede, Andreas H. Gomoll, Casper Bindzus Foldager
    Abstract:

    Objective. To compare demographics and cartilage lesion characteristics of patients enrolled in clinical trials investigating autologous Chondrocyte Implantation (ACI) in the ankle joint with those...

  • Indications, Techniques, Outcomes for Matrix-Induced Autologous Chondrocyte Implantation (MACI)
    Operative Techniques in Sports Medicine, 2018
    Co-Authors: Brandon J. Erickson, Sabrina M. Strickland, Andreas H. Gomoll
    Abstract:

    Symptomatic cartilage defects of the knee are a common problem facing orthopaedic surgeons. Several operative treatments exist for patients who have failed nonoperative management. These treatments can be broadly broken down into reparative and restorative procedures. While reparative procedures can be used on very small defects with moderate to good results, restorative procedures are more effective for larger lesions, and for longer lasting improvements in outcomes over time. Matrix-induced autologous Chondrocyte Implantation (MACI) is a third generation autologous Chondrocyte Implantation product in which the patient's previously harvested Chondrocytes are expanded in culture and seeded onto a collagen scaffold. The technique is indicated for symptomatic articular cartilage defects with minimal subchondral bony involvement. The seeded collagen scaffold is used to cover the articular cartilage defect, using fibrin glue to secure it into place, thus simplifying the technique and addressing some of the issues seen with the first and second generation autologous Chondrocyte Implantation. Clinical results, including patient satisfaction, pain reduction, and ability to return to sport following MACI have been encouraging in short, medium, and long-term studies. MACI is a reliable option for treatment of symptomatic cartilage defects.

  • Autologous Chondrocytes and Next-Generation Matrix-Based Autologous Chondrocyte Implantation.
    Clinics in Sports Medicine, 2017
    Co-Authors: Betina Bremer Hinckel, Andreas H. Gomoll
    Abstract:

    Focal chondral defects of the knee are common and can significantly impair quality of life. The autologous Chondrocyte Implantation technique has evolved over the past 20 years; the newest third-generation technique is matrix-induced autologous Chondrocyte Implantation. Physical examination is important to characterize location and source of pain and identify associated injuries. Imaging studies allow characterization of the lesions, identification of associated lesions, and alignment. Conservative measures should be exhausted before proceeding with surgical treatment. Steps of surgical treatment are diagnostic arthroscopy and biopsy, Chondrocyte culture, and Chondrocyte Implantation. The techniques and their outcomes are discussed in this article.

  • patients scheduled for Chondrocyte Implantation treatment with maci have larger defects than those enrolled in clinical trials
    Cartilage, 2016
    Co-Authors: Casper Bindzus Foldager, Jack Farr, Andreas H. Gomoll
    Abstract:

    ObjectiveTo compare characteristics for patients scheduled for autologous Chondrocyte Implantation with matrix-assisted Chondrocyte Implantation (MACI) with those enrolled in clinical trials and to describe differences in patient selection between countries.DesignAnonymized data from patients scheduled for MACI treatment in the knee in Europe and Australia/Asia were obtained from the Genzyme/Sanofi database. Average age, defect size, and male-female ratio were analyzed and compared by country. Clinical cohort studies and prospective comparative trials using autologous Chondrocyte Implantation and related treatments were identified and weighted average age, weighted defect size, and male-female ratio were analyzed and compared with data from the database.ResultsFrom the database 2,690 patients were included with mean age 33.7 years and male-female ratio of 67:33. Mean defect size was 5.64 cm2 and 70% of the defects were 3 to 10 cm2. There were significant differences between patients’ mean defect sizes bet...

Tom Minas - One of the best experts on this subject based on the ideXlab platform.

  • Survival Analysis of Revision Autologous Chondrocyte Implantation for Failed ACI
    American Journal of Sports Medicine, 2019
    Co-Authors: Takahiro Ogura, Tim Bryant, Gergo Merkely, Brian A. Mosier, Tom Minas
    Abstract:

    Background:Autologous Chondrocyte Implantation (ACI) provides a successful outcome for treating articular cartilage lesions. However, there have been very few reports on the clinical outcomes of re...

  • Autologous Chondrocyte Implantation
    Jbjs Essential Surgical Techniques, 2016
    Co-Authors: Tom Minas, Takahiro Ogura, Tim Bryant
    Abstract:

    [Introduction][1] Autologous Chondrocyte Implantation (ACI) for the treatment of articular cartilage lesions of the knee joint provides successful and durable long-term outcomes. [Indications & Contraindications][2] [Step 1: Preoperative Planning][3] ([Video 1][4]) Obtain standing radiographs and magnetic resonance imaging (MRI) scans to identify all associated abnormalities (background factors). [Step 2: Arthroscopic Assessment and Cartilage Biopsy][5] ([Video 2][6]) Evaluate the knee joint systematically and harvest cartilage tissue from the non-weight-bearing area. [Step 3: Make the Incision for the Arthrotomy][7] ([Video 3][8]) Use a medial or lateral parapatellar arthrotomy and expose the lesion adequately. [Step 4: Prepare the Defect][9] ([Video 4][10]) Debride all fissured and unstable articular cartilage surrounding the full-thickness chondral injury down to healthy contained cartilage. [Step 5: Address Associated Abnormalities][11] Address associated abnormalities (predisposing background factors) to optimize recovery and a successful outcome. [Step 6: Prepare and Fix the Collagen Membrane(s)][12] ([Video 5][13]) Orient the membrane patch with the rough surface to the subchondral bone and the smooth surface toward the articular surface; then sew it, tying the sutures knots on the membrane and not the cartilage, to tension it adequately throughout the entire defect. [Step 7: Chondrocyte Implantation][14] ([Video 6][15]) Gently deliver the cells and fill the defect. [Step 8: Postoperative Care][16] (1) Initiate range-of-motion exercises to enhance Chondrocyte regeneration and decrease the likelihood of intra-articular adhesion, (2) protect the graft from loading for 6 to 12 weeks after surgery to prevent graft overload and central degeneration or delamination of the graft, and (3) initiate isometric muscle exercises to regain muscle tone and prevent atrophy. [Results][17] ACI provided durable outcomes in 210 patients followed prospectively for 10 to 17 years after treatment with the first-generation ACI-periosteum technique[6][18]. [Pitfalls & Challenges][19] [Introduction][1] Autologous Chondrocyte Implantation (ACI) for the treatment of articular cartilage lesions of the knee joint provides successful and durable long-term outcomes. [Indications & Contraindications][2] [Step 1: Preoperative Planning][3] ([Video 1][4]) Obtain standing radiographs and magnetic resonance imaging (MRI) scans to identify all associated abnormalities (background factors). [Step 2: Arthroscopic Assessment and Cartilage Biopsy][5] ([Video 2][6]) Evaluate the knee joint systematically and harvest cartilage tissue from the non-weight-bearing area. [Step 3: Make the Incision for the Arthrotomy][7] ([Video 3][8]) Use a medial or lateral parapatellar arthrotomy and expose the lesion adequately. [Step 4: Prepare the Defect][9] ([Video 4][10]) Debride all fissured and unstable articular cartilage surrounding the full-thickness chondral injury down to healthy contained cartilage. [Step 5: Address Associated Abnormalities][11] Address associated abnormalities (predisposing background factors) to optimize recovery and a successful outcome. [Step 6: Prepare and Fix the Collagen Membrane(s)][12] ([Video 5][13]) Orient the membrane patch with the rough surface to the subchondral bone and the smooth surface toward the articular surface; then sew it, tying the sutures knots on the membrane and not the cartilage, to tension it adequately throughout the entire defect. [Step 7: Chondrocyte Implantation][14] ([Video 6][15]) Gently deliver the cells and fill the defect. [Step 8: Postoperative Care][16] (1) Initiate range-of-motion exercises to enhance Chondrocyte regeneration and decrease the likelihood of intra-articular adhesion, (2) protect the graft from loading for 6 to 12 weeks after surgery to prevent graft overload and central degeneration or delamination of the graft, and (3) initiate isometric muscle exercises to regain muscle tone and prevent atrophy. [Results][17] ACI provided durable outcomes in 210 patients followed prospectively for 10 to 17 years after treatment with the first-generation ACI-periosteum technique[6][18]. [Pitfalls & Challenges][19] [1]: #sec-14 [2]: #sec-15 [3]: #sec-18 [4]: #media-1 [5]: #sec-19 [6]: #media-2 [7]: #sec-20 [8]: #media-3 [9]: #sec-21 [10]: #media-4 [11]: #sec-22 [12]: #sec-23 [13]: #media-5 [14]: #sec-24 [15]: #media-6 [16]: #sec-25 [17]: #sec-26 [18]: #ref-6 [19]: #sec-27

  • the john insall award a minimum 10 year outcome study of autologous Chondrocyte Implantation
    Clinical Orthopaedics and Related Research, 2014
    Co-Authors: Tom Minas, Tim Bryant, Arvind Von Keudell, Andreas H. Gomoll
    Abstract:

    Background Autologous Chondrocyte Implantation (ACI) has demonstrated good and excellent results in over 75% of patients up to 10 years after surgery. Reports of longer-term outcomes, however, remain limited.

  • increased failure rate of autologous Chondrocyte Implantation after previous treatment with marrow stimulation techniques
    Orthopaedic Proceedings, 2012
    Co-Authors: Tom Minas, Andreas H. Gomoll, Ralf Rosenberger, R Royce, Tim Bryant
    Abstract:

    Hypothesis Cartilage defects pretreated with marrow stimulation techniques will have an increased failure rate. The first 321 consecutive patients treated at one institution with autologous Chondrocyte Implantation for full-thickness cartilage defects that reached more than two years of follow-up were evaluated by prospectively collected data. Patients were grouped based on whether they had undergone prior treatment with a marrow stimulation technique. Outcomes were classified as complete failure if more than 25% of a grafted defect area had to be removed in later procedures because of persistent symptoms. Results There were 522 defects in 321 patients (325 joints) treated with autologous Chondrocyte Implantation. On average, there were 1.7 lesions per patient. Of these joints, 111 had previously undergone surgery that penetrated the subchondral bone; 214 joints had no prior treatment that affected the subchondral bone and served as controls. Within the marrow stimulation group, there were 29 (26%) failures, compared with 17 (8%) failures in the control group. Conclusion Defects that had prior treatment affecting the subchondral bone failed at a rate three times that of nontreated defects. The failure rates for drilling (28%), abrasion arthroplasty (27%), and microfracture (20%) were not significantly different—possibly because of the lower number of microfracture patients in this cohort (25 of 110 marrow-stimulation procedures). The data demonstrate that marrow stimulation techniques have a strong negative effect on subsequent cartilage repair with autologous Chondrocyte Implantation and, therefore, should be used judiciously in larger cartilage defects that could require future treatment with autologous Chondrocyte Implantation. Unlike coventional wisdom, MSTs do ‘burn bridges’.

  • use of a type i iii bilayer collagen membrane decreases reoperation rates for symptomatic hypertrophy after autologous Chondrocyte Implantation
    American Journal of Sports Medicine, 2009
    Co-Authors: Andreas H. Gomoll, B Cole, Jack Farr, Christian Probst, Tom Minas
    Abstract:

    BackgroundAutologous 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.HypothesisThe use of a collagen membrane for autologous Chondrocyte Implantation will decrease reoperation rates for hypertrophy with comparable rates of failure.Study DesignCohort study; Level of evidence, 3.MethodsA 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 failur...

Jack Farr - One of the best experts on this subject based on the ideXlab platform.

  • patients scheduled for Chondrocyte Implantation treatment with maci have larger defects than those enrolled in clinical trials
    Cartilage, 2016
    Co-Authors: Casper Bindzus Foldager, Jack Farr, Andreas H. Gomoll
    Abstract:

    ObjectiveTo compare characteristics for patients scheduled for autologous Chondrocyte Implantation with matrix-assisted Chondrocyte Implantation (MACI) with those enrolled in clinical trials and to describe differences in patient selection between countries.DesignAnonymized data from patients scheduled for MACI treatment in the knee in Europe and Australia/Asia were obtained from the Genzyme/Sanofi database. Average age, defect size, and male-female ratio were analyzed and compared by country. Clinical cohort studies and prospective comparative trials using autologous Chondrocyte Implantation and related treatments were identified and weighted average age, weighted defect size, and male-female ratio were analyzed and compared with data from the database.ResultsFrom the database 2,690 patients were included with mean age 33.7 years and male-female ratio of 67:33. Mean defect size was 5.64 cm2 and 70% of the defects were 3 to 10 cm2. There were significant differences between patients’ mean defect sizes bet...

  • Autologous Chondrocyte Implantation (ACI)
    Cartilage Restoration, 2013
    Co-Authors: Andreas H. Gomoll, Jack Farr
    Abstract:

    Autologous Chondrocyte Implantation (ACI) was one of the first tissue engineering products, utilizing autologous Chondrocytes grown in culture and reimplanted in a second-stage procedure to repair large chondral defects. Originally developed (and currently approved in the USA) with the use of a periosteal flap, most ACI procedures are currently performed with a collagen membrane in place of the periosteum.

  • use of a type i iii bilayer collagen membrane decreases reoperation rates for symptomatic hypertrophy after autologous Chondrocyte Implantation
    American Journal of Sports Medicine, 2009
    Co-Authors: Andreas H. Gomoll, B Cole, Jack Farr, Christian Probst, Tom Minas
    Abstract:

    BackgroundAutologous 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.HypothesisThe use of a collagen membrane for autologous Chondrocyte Implantation will decrease reoperation rates for hypertrophy with comparable rates of failure.Study DesignCohort study; Level of evidence, 3.MethodsA 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 failur...

  • Use of a type I/III bilayer collagen membrane decreases reoperation rates for symptomatic hypertrophy after autologous Chondrocyte Implantation.
    The American journal of sports medicine, 2009
    Co-Authors: Andreas H. Gomoll, Jack Farr, Christian Probst, Brian J Cole, Tom Minas
    Abstract:

    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. The use of a collagen membrane for autologous Chondrocyte Implantation will decrease reoperation rates for hypertrophy with comparable rates of failure. Cohort study; Level of evidence, 3. 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. 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. 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.

  • a prospective study of autologous Chondrocyte Implantation in patients with failed prior treatment for articular cartilage defect of the knee results of the study of the treatment of articular repair star clinical trial
    American Journal of Sports Medicine, 2009
    Co-Authors: Kenneth Zaslav, B Cole, Jack Farr, Robert Brewster, Thomas M Deberardino, Peter J Fowler, Carl W Nissen
    Abstract:

    BackgroundThis is a prospective clinical study to assess the effectiveness of autologous Chondrocyte Implantation in patients who failed prior treatments for articular cartilage defects of the knee.HypothesisAutologous Chondrocyte Implantation provides clinical benefit in patients with failed articular cartilage treatments.Study DesignCohort study; Level of evidence, 2.MethodsOne hundred fifty-four patients with failed treatment for articular cartilage defects of the knee received autologous Chondrocyte Implantation in a multicenter, prospective study. Follow-up was 48 months. Outcomes included change from baseline in knee function, knee pain, quality of life, and overall health. Duration of benefit after autologous Chondrocyte Implantation was compared with the failed prior non—autologous Chondrocyte Implantation procedure. Safety information was recorded. Additional analyses were performed on the 2 major cohorts of prior procedures entered into the study, marrow-stimulation technique or debridement alon...

B Cole - One of the best experts on this subject based on the ideXlab platform.

G Bentley - One of the best experts on this subject based on the ideXlab platform.

  • autologous Chondrocyte Implantation in the knee mid term to long term results
    Journal of Bone and Joint Surgery American Volume, 2014
    Co-Authors: Syed Zuhair Nawaz, G Bentley, John A. Skinner, Richard Carrington, T Briggs, K Gallagher, Baljinder S Dhinsa
    Abstract:

    Background: From 1998 to 2008, 1000 skeletally mature patients underwent autologous Chondrocyte Implantation for an osteochondral defect of the knee. We evaluated the functional outcomes in 827 of 869 patients who had undergone autologous Chondrocyte Implantation with Chondron or periosteum (ACI-C/ACI-P) or matrix-assisted Chondrocyte Implantation (MACI) and attempted to identify factors that influenced outcome. Methods: The age of the patient, the size and site of the osteochondral lesion, previous surgery, and the presence of early osteoarthritis were assessed for their influence on outcomes. Each factor was evaluated in a separate Cox proportional hazards model with use of hazard ratios (HRs), with 95% confidence intervals (CIs), describing the likelihood of failure for that particular factor. Outcomes were assessed with use of the modified Cincinnati score, visual analog scale pain score, and Stanmore functional score. Results: The mean duration of follow-up was 6.2 years (range, two to twelve years). The mean age was thirty-four years (range, fourteen to fifty-six years), with 493 males and 334 females. The average size of the defect was 409 mm2 (range, 64 to 2075 mm2). Four hundred and twenty-one procedures (51%) were performed on the medial femoral condyle; 109 (13%), on the lateral femoral condyle; 200 (24%), on the patella; and fifty (6%), on the trochlea. Kaplan-Meier survival analysis revealed that the unadjusted graft survival rate was 78.2% at five years and 50.7% and ten years for the entire cohort. No difference was found between the survival rates of the ACI-C/ACI-P and MACI techniques (HR = 0.948, 95% CI = 0.738 to 1.219, p = 0.678). There was a significant postoperative improvement in the function and pain scores of all three outcome measures (p < 0.002). Survivorship in the group with a previous cartilage regenerative procedure was inferior to that in patients with a previously untreated lesion, with failure five times more likely in the former group (HR = 4.718, standard error [SE] = 0.742, 95% CI = 3.466 to 6.420, p < 0.001). Degenerative change in any compartment had a significant detrimental effect on survivorship, with survivorship worsening as the osteoarthritis grade increased (Grade 1: HR = 2.077, 95% CI = 1.299 to 3.322, p = 0.002; Grade 2: HR = 3.450, 95% CI = 2.646 to 4.498, p < 0.001; and Grade 3: HR = 3.820, 95% CI = 2.185 to 6.677, p < 0.001). Conclusions: Our study demonstrated an overall graft survival of 78% at five years and 51% beyond ten years following both autologous Chondrocyte Implantation techniques. Despite study limitations, our results demonstrate that autologous Chondrocyte Implantation for the treatment of osteochondral defects of the knee can achieve good results. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • A752. AUTOLOGOUS Chondrocyte Implantation IN THE ADOLESCENT KNEE
    2011
    Co-Authors: S. Macmull, G Bentley, M.t.r. Parratt, John A. Skinner, Richard Carrington, Timothy W. R. Briggs
    Abstract:

    Autologous Chondrocyte Implantation (ACII) has been shown to have favourable results in the treatment of symptomatic chondral and osteochondral lesions. However, there are few reports on the outcomes of this technique in adolescents. The aim was to assess functional outcome and pain relief in adolescents undergoing autologous Chondrocyte Implantation (ACI). Thirty-one adolescent patients undergoing ACI or Matrix-assisted Chondrocyte Implantation (MACI) were identified from a larger prospective study. Mean age was 16.3 years (range 14 – 18) with a mean follow-up of 66.3 months (12–126 months). There were 22 males and nine females. All patients were symptomatic; 30 had isolated lesions and one had multiple lesions. Patients were assessed pre and postoperatively using the Visual Analogue Score (VAS), the Stanmore/Bentley Functional Rating Score and the Modified Cincinnati Rating System. The mean VAS improved from 5.8 pre-operatively to 2 post-operatively. The Stanmore/Bentley Functional Rating Score improved from 2.9 to 0.9 whilst the Modified Cincinnati Rating System improved from 49.8 pre-operatively to 81.3 postoperatively with 87% of patients achieving excellent or good results. All postoperative scores exhibited statistically significant improvement from pre-operative scores. The results show that, in this particular group of patients, this procedure produces reduction in pain and a statistically significant improvement in function postoperatively. We strongly recommend this procedure in the management of adolescents with symptomatic chondral defects.

  • Autologous Chondrocyte Implantation in the Adolescent Knee
    American Journal of Sports Medicine, 2011
    Co-Authors: S. Macmull, G Bentley, M.t.r. Parratt, John A. Skinner, Richard Carrington, Tim P. Morris, Timothy W. R. Briggs
    Abstract:

    BackgroundAutologous Chondrocyte Implantation (ACI) has been shown to have favorable results in the treatment of symptomatic chondral and osteochondral lesions. However, there are few reports on the outcomes of this technique in adolescents.PurposeThe aim of this study was to assess pain relief and functional outcome in adolescents undergoing ACI.Study DesignCase series; Level of evidence, 4.MethodsThirty-five adolescent patients undergoing ACI or matrix-assisted Chondrocyte Implantation (MACI) were identified from a larger cohort. Four patients were lost to follow-up, leaving 31 patients (24 ACI, 7 MACI). The mean age was 16.3 years (range, 14-18 years) with a mean follow-up of 66.3 months (range, 12-126 months). There were 22 male and 9 female patients. All patients were symptomatic; 30 had isolated lesions and 1 had multiple lesions. Patients were assessed preoperatively and post-operatively using the visual analog scale (VAS) score for pain, the Bentley Functional Rating Score, and the Modified Cincin...

  • A CORRELATION BETWEEN TIMING OF POST-AUTOLOGOUS Chondrocyte Implantation BIOPSY AND HISTOLOGY
    2010
    Co-Authors: P.d. Gikas, R. Carrington, J. Skinner, T.w.r. Briggs, G Bentley
    Abstract:

    Introduction: Autologous Chondrocyte Implantation (ACI) is a treatment option for full-thickness chondral, or osteochondral injuries that are painful and debilitating. Goals of surgery and rehabilitation include replacement of damaged cartilage with hyaline or hyaline-like cartilage, leading eventually to improved level of function. Intermediate and long-term results are promising in terms of functional and clinical improvement. Purpose: To explore the hypothesis that the quality of the repair tissue, formed following Autologous Chondrocyte Implantation (ACI), improves with time post-surgery. Methods and Results: Two hundred and forty eight patients who underwent autologous Chondrocyte Implantation in our institution were studied after having had post Implantation biopsies of the repair tissue. Mean timing of biopsy was 14.8 months (range 3–55). 59 biopsies gave hyaline tissue (24%), 67 mixed hyaline and fibrocartilage (27%), 113 biopsies were fibrocartilage only (46%) and 9 patients had a fibrous tissue biopsy result (9%). Due to NHS restraints and waiting list targets biopsies were actually performed at various time points post Implantation allowing us to statistically correlate histological findings with the maturity of the repair tissue. Our statistical analysis suggests that if time post Implantation doubles then the likelihood of a favourable histological outcome increases significantly. Conclusion: Autologous Chondrocyte Implantation forms a durable repair tissue that remodels and continues to improve in quality with time. It is recommended that for future research/study purposes 24 months is used as an optimal time to look at histology, since our data show that outcome is still improving until this point.

  • does smoking influence outcome after autologous Chondrocyte Implantation a case controlled study
    Journal of Bone and Joint Surgery-british Volume, 2009
    Co-Authors: P.k. Jaiswal, G Bentley, S. Macmull, John A. Skinner, R. Carrington, T.w.r. Briggs
    Abstract:

    Smoking is known to have an adverse effect on wound healing and musculoskeletal conditions. This case-controlled study looked at whether smoking has a deleterious effect in the outcome of autologous Chondrocyte Implantation for the treatment of full thickness chondral defects of the knee.The mean Modified Cincinatti Knee score was statistically significantly lower in smokers (n = 48) than in non-smokers (n = 66) both before and after surgery (p < 0.05). Smokers experienced significantly less improvement in the knee score two years after surgery (p < 0.05). Graft failures were only seen in smokers (p = 0.016). There was a strong negative correlation between the number of cigarettes smoked and the outcome following surgery (Pearson’s correlation coefficient −0.65, p = 0.004).These results suggest that patients who smoke have worse pre-operative function and obtain less benefit from this procedure than non-smokers. The counselling of patients undergoing autologous Chondrocyte Implantation should include smok...