Mont M A, Jones L C, Vogelstein B N, Hungerford D S
Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, The Good Samaritan Hospital, Baltimore, Maryland, USA.
Am J Sports Med. 1999 Sep-Oct;27(5):617-20. doi: 10.1177/03635465990270051201.
Autologous chondrocyte transplantation is a new procedure developed for the treatment of focal articular cartilage defects of the knee. The exact indications and limitations of this procedure have not yet been completely defined through prospective, randomized studies. The purpose of this study was to examine the indications and contraindications for surgery in consecutive cases initially rejected for reimbursement of surgical expenses by insurance companies, but now on appeal, to assess whether patients referred by the physicians met the procedure criteria. Twenty-four consecutive candidates were referred for adjudication when the recommending orthopaedic surgeon appealed a rejection by a medical reviewer. The factors examined included the number and size of the cartilage lesions, the presence of tricompartmental arthritis, transplantation proposed for patellar lesions, patient age, and sagittal plane deformity. In 23 of 24 cases (96%) the indications for the procedure were not met or specific contraindications were present. In 15 of 24 cases (63%) there were multiple contraindications. The results of this study underscore the importance of controlled, application-limited experience before the release of new procedures for widespread clinical applications. The uncontrolled use of this procedure may negatively skew the overall results for this technique, prejudicing a procedure that may be successful for the correct indications.
自体软骨细胞移植是一种为治疗膝关节局灶性关节软骨缺损而研发的新方法。该方法的确切适应症和局限性尚未通过前瞻性随机研究完全明确。本研究的目的是检查连续病例的手术适应症和禁忌症，这些病例最初被保险公司拒绝报销手术费用，但目前正在上诉，以评估医生转诊的患者是否符合手术标准。当推荐的骨科医生对医学审核员的拒绝提出上诉时，连续24名候选人被转诊进行裁决。检查的因素包括软骨损伤的数量和大小、三关节关节炎的存在、针对髌骨损伤提出的移植、患者年龄和矢状面畸形。在24例病例中的23例（96%）中，该手术的适应症未得到满足或存在特定禁忌症。在24例病例中的15例（63%）中存在多种禁忌症。本研究结果强调了在新方法广泛应用于临床之前进行有控制、应用受限经验的重要性。该方法的无控制使用可能会对该技术的总体结果产生负面影响，损害一种可能对正确适应症有效的手术方法。
