Periosteum-covered ACI (ACI-P) versus collagen membrane ACI (ACI-C): A single-surgeon, large cohort analysis of clinical outcomes and graft survivorship
Introduction: Autologous chondrocyte implantation (ACI) has undergone several technical modifications. Objectives: To compare clinical outcomes and graft survivorship between ''first-generation'' periosteum-covered ACI (ACI-P) and ''second-generation'' collage...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-06-01
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| Series: | Journal of Cartilage & Joint Preservation |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S266725452100010X |
| _version_ | 1818690203611561984 |
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| author | Liana Leja, MS Tom Minas, MD, MS |
| author_facet | Liana Leja, MS Tom Minas, MD, MS |
| author_sort | Liana Leja, MS |
| collection | DOAJ |
| description | Introduction: Autologous chondrocyte implantation (ACI) has undergone several technical modifications. Objectives: To compare clinical outcomes and graft survivorship between ''first-generation'' periosteum-covered ACI (ACI-P) and ''second-generation'' collagen membrane ACI (ACI-C). Methods: A total of 400 consecutive ACI cases performed by a single surgeon were reviewed. Of the total, 200 were treated with ACI-P and 200 ACI-C. Patients with a minimum follow-up of 2 years were included (ACI-P, n = 112; ACI-C, n = 94). A separate long-term analysis was completed with a mean follow-up of 9 ± 1.8 years in the ACI-P group and 12 ± 2.2 years in the ACI-C group. Clinical outcomes and graft survivorship were compared at both follow-up intervals. Predictors of treatment failures and subsequent surgical procedures (SSPs) were identified. Results: Treatment failures were significantly greater among ACI-P cases compared to ACI-C, P = .007 with a greater proportion of cases with disease progression in the ACI-P cohort, P = .022. SSPs were greater in the ACI-P cohort, P < .001. Debridement for symptomatic hypertrophy was the most frequently performed SSP among ACI-P cases. ACI generation and prior marrow stimulation were significant predictors of treatment failures and SSPs. There were significant mean improvements in patient subjective responses within treatment groups. No differences in patient subjective responses were observed between ACI generations. Cumulative graft survivorship was greater in the ACI-C cohort (P = .024). Conclusions: The use of ACI-C improved clinical outcomes with a reduction in treatment failures, SSPs, and graft hypertrophy, allowing the surgeon to treat a greater number of bipolar and multiple lesion cases with similar functional outcomes when compared to ACI-P. |
| first_indexed | 2024-12-17T12:22:16Z |
| format | Article |
| id | doaj.art-19672149724e4f3cb6cf91b437016296 |
| institution | Directory Open Access Journal |
| issn | 2667-2545 |
| language | English |
| last_indexed | 2024-12-17T12:22:16Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cartilage & Joint Preservation |
| spelling | doaj.art-19672149724e4f3cb6cf91b4370162962022-12-21T21:48:54ZengElsevierJournal of Cartilage & Joint Preservation2667-25452021-06-0112100010Periosteum-covered ACI (ACI-P) versus collagen membrane ACI (ACI-C): A single-surgeon, large cohort analysis of clinical outcomes and graft survivorshipLiana Leja, MS0Tom Minas, MD, MS1Cartilage Repair Center, Paley Orthopedic & Spine Institute, West Palm Beach, Florida, USA; Liana Leja, 412-527-2736, 901 45th Street, Kimmel Building, West Palm Beach, FL 33407.Cartilage Repair Center, Paley Orthopedic & Spine Institute, Harvard Medical School, Boston, Massachusetts, West Palm Beach, Florida, USA,Introduction: Autologous chondrocyte implantation (ACI) has undergone several technical modifications. Objectives: To compare clinical outcomes and graft survivorship between ''first-generation'' periosteum-covered ACI (ACI-P) and ''second-generation'' collagen membrane ACI (ACI-C). Methods: A total of 400 consecutive ACI cases performed by a single surgeon were reviewed. Of the total, 200 were treated with ACI-P and 200 ACI-C. Patients with a minimum follow-up of 2 years were included (ACI-P, n = 112; ACI-C, n = 94). A separate long-term analysis was completed with a mean follow-up of 9 ± 1.8 years in the ACI-P group and 12 ± 2.2 years in the ACI-C group. Clinical outcomes and graft survivorship were compared at both follow-up intervals. Predictors of treatment failures and subsequent surgical procedures (SSPs) were identified. Results: Treatment failures were significantly greater among ACI-P cases compared to ACI-C, P = .007 with a greater proportion of cases with disease progression in the ACI-P cohort, P = .022. SSPs were greater in the ACI-P cohort, P < .001. Debridement for symptomatic hypertrophy was the most frequently performed SSP among ACI-P cases. ACI generation and prior marrow stimulation were significant predictors of treatment failures and SSPs. There were significant mean improvements in patient subjective responses within treatment groups. No differences in patient subjective responses were observed between ACI generations. Cumulative graft survivorship was greater in the ACI-C cohort (P = .024). Conclusions: The use of ACI-C improved clinical outcomes with a reduction in treatment failures, SSPs, and graft hypertrophy, allowing the surgeon to treat a greater number of bipolar and multiple lesion cases with similar functional outcomes when compared to ACI-P.http://www.sciencedirect.com/science/article/pii/S266725452100010XAutologous chondrocyte implantationGraft survivorshipPeriosteal hypertrophyChondral defectsOsteochondral defectsKnee |
| spellingShingle | Liana Leja, MS Tom Minas, MD, MS Periosteum-covered ACI (ACI-P) versus collagen membrane ACI (ACI-C): A single-surgeon, large cohort analysis of clinical outcomes and graft survivorship Journal of Cartilage & Joint Preservation Autologous chondrocyte implantation Graft survivorship Periosteal hypertrophy Chondral defects Osteochondral defects Knee |
| title | Periosteum-covered ACI (ACI-P) versus collagen membrane ACI (ACI-C): A single-surgeon, large cohort analysis of clinical outcomes and graft survivorship |
| title_full | Periosteum-covered ACI (ACI-P) versus collagen membrane ACI (ACI-C): A single-surgeon, large cohort analysis of clinical outcomes and graft survivorship |
| title_fullStr | Periosteum-covered ACI (ACI-P) versus collagen membrane ACI (ACI-C): A single-surgeon, large cohort analysis of clinical outcomes and graft survivorship |
| title_full_unstemmed | Periosteum-covered ACI (ACI-P) versus collagen membrane ACI (ACI-C): A single-surgeon, large cohort analysis of clinical outcomes and graft survivorship |
| title_short | Periosteum-covered ACI (ACI-P) versus collagen membrane ACI (ACI-C): A single-surgeon, large cohort analysis of clinical outcomes and graft survivorship |
| title_sort | periosteum covered aci aci p versus collagen membrane aci aci c a single surgeon large cohort analysis of clinical outcomes and graft survivorship |
| topic | Autologous chondrocyte implantation Graft survivorship Periosteal hypertrophy Chondral defects Osteochondral defects Knee |
| url | http://www.sciencedirect.com/science/article/pii/S266725452100010X |
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