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Implants best for full-thickness articular cartilage knee lesions. (Autologous Chondrocytes).

TORONTO -- Autologous chondrocyte implantation beat marrow stimulation for treating full-thickness articular cartilage lesions of the knee, according to the results of a multicenter, prospective, controlled trial.

At 3-5 years after surgery, patients who underwent autologous chondrocyte implantation (ACI) had significantly fewer symptoms, greater functional improvement, and a lower treatment failure rate than subjects who underwent marrow stimulation techniques, Dr. Christoph Erggelet reported at a symposium of the International Cartilage Repair Society.

He reported on 66 consecutive patients with at least one highly symptomatic femoral cartilage defect of 2 cm or more in size and no treated patellar or tibial defects. Half of the patients received ACI; the others underwent marrow stimulation surgery (microfracture, drilling, or abrasion).

Although this wasn't a randomized trial, the two patient groups were similar demographically with a single exception: At enrollment, patients who were selected for ACI had more impairments and symptoms. In that group, 70% had undergone one or more prior knee cartilage surgeries, compared with 36% of those who were assigned to marrow stimulation surgery.

At 3-5 years after surgery, the ACI group reported a mean 3.8-point improvement in their overall condition from a baseline of 3.1 on a 10-point scale. Patients who underwent marrow stimulation had a mean 1.2-point improvement from a baseline of 4.1, said Dr. Erggelet, an orthopedic surgeon at the University of Freiburg (Germany).

Pain scores improve by a mean of 3.9 points in the ACT group and by 1.5 points in the marrow stimulation group. Joint swelling scores improved by 4.1 points in the ACT group, compared with 1.1 points in patients who underwent marrow stimulation surgery he continued.

Seven patients in the marrow stimulation technique group were deemed treatment failures. They underwent a total of seven subsequent operations, including four ACIs and one total knee replacement. There were two treatment failures in the ACI group.
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Author:Jancin, Bruce
Publication:Internal Medicine News
Date:Feb 1, 2003
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