Affiliation:
1. Department of Orthopedics and Trauma Surgery Medical University of Vienna AKH Wien Waehringer Guertel 18‐20 1090 Vienna Austria
2. OCM Munich Germany
3. Department of Orthopaedic Sports Medicine Hospital Rechts Der Isar Technical University of Munich Munich Germany
4. The Steadman Philippon Research Institute 181 West Meadows Drive, Suite 400 Vail CO USA
5. Brigham and Women’s Hospital Harvard Medical School Boston MA USA
6. Department of Orthopedics and Trauma Surgery University Medical Center Freiburg Albert‐Ludwig University of Freiburg Freiburg Germany
Abstract
AbstractPurposeThis study aimed to analyze the risk of reoperation following autologous chondrocyte implantation (ACI) of the knee utilizing third‐generation ACI products in a time‐to‐event analysis and report on the associated patient‐reported outcome measures (PROM) in case of reoperation.MethodsPatients undergoing ACI were included from a longitudinal database. Patient age, sex, body mass index (BMI), number of previous surgeries, lesion localization, lesion size, symptom duration, as well as time and type of reoperation was extracted. A cox proportional‐hazards model was applied to investigate the influence of baseline variables on risk of reoperation. Reoperation was defined as any type of subsequent ipsilateral knee surgery, excluding hardware removal. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was utilized to compare PROM between patients with and without reoperation.ResultsA total of 2039 patients were included with 1359 (66.7%) having a minimum follow‐up of 24 months. There were overall 243 reoperations (prevalence 17.9%). Minor arthroscopic procedures (n = 96, 39.5%) and revision cartilage repair procedures (n = 78, 32.1%) were the most common reoperations. Nineteen patients (0.9%) reported conversion arthroplasty at 17.7 (10.4) months after ACI. Female sex (HR 1.5, 95% CI [1.2, 2.0], p = 0.002) and the presence of 1–2 previous surgeries (HR 1.5, 95% CI [1.1, 2.0], p = 0.010), or more than 2 previous surgeries (HR 1.9, 95% CI [1.2, 2.9], p = 0.004) were significantly associated with increased risk of reoperation following ACI. Significantly less patients surpassed the minimal clinically important difference (MCID) in the reoperation group at 24 months regarding the KOOS subscores pain (OR 1.6, 95% CI [1.1, 2.2]), quality of life (OR 2.2, 95% CI [1.6, 3.2]), symptoms (OR 2.0 [1.4, 2.9]), and sports (OR 2.0 [1.4, 2.8]).ConclusionFemale patients and individuals with a history of previous surgeries face an elevated risk of requiring reoperation after undergoing ACI, which is associated with failure to attain clinically relevant improvements. A thorough evaluation of the indications for ACI is paramount, particularly when patients have a history of previous surgeries.Level of evidenceLevel III.
Funder
Medical University of Vienna
Medizinische Universität Wien
Subject
Orthopedics and Sports Medicine,Surgery