Yale School of Medicine, New Haven, Connecticut, USA.
MedStar Health/Georgetown University Hospital Program, Washington DC, USA.
Am J Sports Med. 2022 Sep;50(11):2893-2899. doi: 10.1177/03635465221111115. Epub 2022 Aug 2.
Autologous chondrocyte implantation (ACI) can be used to treat focal, full-thickness chondral defects of the knee. However, there is limited large-sample evidence available regarding the incidence, timing, and risk factors for revision surgery after ACI.
To assess the 5-year incidence, timing, and risk factors for revision surgery after ACI in a large national cohort.
Case series; Level of evidence, 4.
The 2010-2020 PearlDiver database was queried for patients aged 20 to 59 years who underwent primary ACI of the knee without previous chondral procedures or knee arthroplasty. Revision surgery was defined as subsequent revision ACI, osteochondral allograft transplantation, osteochondral autograft transfer, unicompartmental knee arthroplasty, or total knee arthroplasty within 5 years. Kaplan-Meier analysis was used to assess both incidence and timing of revision surgery. Risk factors evaluated for revision surgery included patient age, sex, body mass index (BMI), Elixhauser Comorbidity Index (ECI) score, and previous or concomitant bony realignment procedures.
In total, 533 patients underwent primary ACI and met inclusion criteria. The 5-year incidence of revision surgery was 10.3%, with 63% of revisions occurring in the first 2 years after surgery. Risk factors associated with revision surgery included female sex (odds ratio, 2.58; 95% CI, 1.22-5.45; = .013) and BMI ≥35 (odds ratio, 2.24; 95% CI, 1.01-4.94; = .047). There was no relationship between age, ECI score, or previous or concomitant bony realignment procedures and revision surgery at 5 years ( > .05).
In an analysis of 533 patients who underwent ACI, 10.3% required a subsequent articular cartilage procedure or conversion to knee arthroplasty in the first 5 postoperative years. Revision surgery was greatest in the first 2 postoperative years. Female sex and severe obesity (BMI, ≥35) were associated with increased risk of revision surgery, while age, ECI score, and previous or concomitant bony realignment procedures were not. These findings suggest that treatment of chondral defects of the knee with ACI is associated with durable outcomes at the 5-year follow-up.
自体软骨细胞移植（ACI）可用于治疗膝关节局灶性、全层软骨缺损。然而，关于 ACI 后翻修手术的发生率、时间和风险因素，目前仅有有限的大样本证据。
在一个大型全国队列中评估 ACI 后 5 年翻修手术的发生率、时间和风险因素。
病例系列；证据水平，4 级。
在 2010 年至 2020 年的 PearlDiver 数据库中，检索了 20 至 59 岁行膝关节初次 ACI 且无先前软骨手术或膝关节置换术的患者。翻修手术定义为 5 年内行后续的 ACI 翻修、骨软骨同种异体移植、骨软骨自体移植转移、单髁膝关节置换或全膝关节置换。采用 Kaplan-Meier 分析评估翻修手术的发生率和时间。评估翻修手术的风险因素包括患者年龄、性别、体重指数（BMI）、Elixhauser 合并症指数（ECI）评分以及先前或同时行骨矫形手术。
共有 533 例患者行初次 ACI 并符合纳入标准。5 年翻修手术的发生率为 10.3%，63%的翻修手术发生在术后 2 年内。与翻修手术相关的风险因素包括女性（比值比，2.58；95%置信区间，1.22-5.45； =.013）和 BMI≥35（比值比，2.24；95%置信区间，1.01-4.94； =.047）。在 5 年时，年龄、ECI 评分以及先前或同时行骨矫形手术与翻修手术之间无相关性（ >.05）。
在对 533 例接受 ACI 治疗的患者进行分析后发现，在术后 5 年内，有 10.3%的患者需要进行后续的关节软骨手术或转换为膝关节置换术。翻修手术在术后 2 年内发生率最高。女性和严重肥胖（BMI≥35）与翻修手术风险增加相关，而年龄、ECI 评分和先前或同时行骨矫形手术与翻修手术风险无关。这些发现表明，ACI 治疗膝关节软骨缺损的 5 年随访结果是持久的。
