PMID- 37950850
OWN - NLM
STAT- MEDLINE
DCOM- 20231216
LR  - 20231216
IS  - 1433-7347 (Electronic)
IS  - 0942-2056 (Print)
IS  - 0942-2056 (Linking)
VI  - 31
IP  - 12
DP  - 2023 Dec
TI  - Increased risk of reoperation and failure to attain clinically relevant 
      improvement following autologous chondrocyte implantation of the knee in female 
      patients and individuals with previous surgeries: a time-to-event analysis based 
      on the German cartilage registry (KnorpelRegister DGOU).
PG  - 5837-5847
LID - 10.1007/s00167-023-07615-5 [doi]
AB  - PURPOSE: This 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. METHODS: 
      Patients 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. RESULTS: A 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]). CONCLUSION: Female 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 
      EVIDENCE: Level III.
CI  - (c) 2023. The Author(s).
FAU - Bumberger, Alexander
AU  - Bumberger A
AUID- ORCID: 0000-0001-9438-0718
AD  - Department of Orthopedics and Trauma Surgery, Medical University of Vienna, AKH 
      Wien, Waehringer Guertel 18-20, 1090, Vienna, Austria. 
      alexander.bumberger@meduniwien.ac.at.
AD  - OCM, Munich, Germany. alexander.bumberger@meduniwien.ac.at.
FAU - Rupp, Marco Christopher
AU  - Rupp MC
AD  - The Steadman Philippon Research Institute, 181 West Meadows Drive, Suite 400, 
      Vail, CO, USA.
AD  - Department of Orthopaedic Sports Medicine, Hospital Rechts Der Isar, Technical 
      University of Munich, Munich, Germany.
FAU - Lattermann, Christian
AU  - Lattermann C
AD  - Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
FAU - Kleiner, Anne
AU  - Kleiner A
AD  - Department of Orthopedics and Trauma Surgery, Medical University of Vienna, AKH 
      Wien, Waehringer Guertel 18-20, 1090, Vienna, Austria.
FAU - Niemeyer, Philipp
AU  - Niemeyer P
AD  - OCM, Munich, Germany.
AD  - Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, 
      Albert-Ludwig University of Freiburg, Freiburg, Germany.
LA  - eng
PT  - Journal Article
DEP - 20231111
PL  - Germany
TA  - Knee Surg Sports Traumatol Arthrosc
JT  - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
JID - 9314730
SB  - IM
MH  - Humans
MH  - Female
MH  - *Chondrocytes
MH  - Reoperation
MH  - Quality of Life
MH  - *Cartilage, Articular/surgery/injuries
MH  - Transplantation, Autologous/methods
MH  - Knee Joint/surgery
MH  - Registries
PMC - PMC10719132
OTO - NOTNLM
OT  - ACI
OT  - Analysis
OT  - Articular
OT  - Autologous chondrocyte implantation
OT  - Autologous chondrocyte transplantation
OT  - Cartilage
OT  - Complication
OT  - Failure
OT  - Joint
OT  - Knee
OT  - Regeneration
OT  - Registry
OT  - Restoration
OT  - Revision
OT  - Survival
COIS- Philipp Niemeyer is an independent consultant for Arthrex, Stryker, Geistlich and 
      Tetec. Christian Lattermann is an independent consultant for Vericel.
EDAT- 2023/11/11 20:50
MHDA- 2023/12/17 10:19
PMCR- 2023/11/11
CRDT- 2023/11/11 11:14
PHST- 2023/06/06 00:00 [received]
PHST- 2023/09/28 00:00 [accepted]
PHST- 2023/12/17 10:19 [medline]
PHST- 2023/11/11 20:50 [pubmed]
PHST- 2023/11/11 11:14 [entrez]
PHST- 2023/11/11 00:00 [pmc-release]
AID - 10.1007/s00167-023-07615-5 [pii]
AID - 7615 [pii]
AID - 10.1007/s00167-023-07615-5 [doi]
PST - ppublish
SO  - Knee Surg Sports Traumatol Arthrosc. 2023 Dec;31(12):5837-5847. doi: 
      10.1007/s00167-023-07615-5. Epub 2023 Nov 11.