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Knee: S. P. Krishnan, J. A. Skinner, W. Bartlett, R. W. J. Carrington, A. M. Flanagan, T. W. R. Briggs, and G. Bentley Who is the ideal candidate for autologous chondrocyte implantation? J Bone Joint Surg Br 2006; 88-B: 61-64 [Abstract] [Full text] [PDF]

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Selecting patients for Autologous chondrocyte implantation

Harish V Kurup   (23 January 2006)

Selecting patients for Autologous chondrocyte implantation 23 January 2006
Harish V Kurup, Specialist Registrar in Orthopaedics Ysbyty Gwynedd, Bangor LL57 2PW Send letter to journal: Re: Selecting patients for Autologous chondrocyte implantation harishkurup{at}gmail.com Harish V Kurup	Sir, I read this article with interest. The authors have given a very good description to aid in selection of patients for referral to specialist centres for consideration of ACI (Autologous chondrocyte implantation). However, I do have some questions for the authors. 1. They have not specified whether they have repeated diagnostic arthroscopy at their centre before the patient was considered for ACI. (Most of the patients are usually referred to a suitable centre after a diagnostic arthroscopy at the peripheral centre). And if they did, was this counted as an additional surgical procedure for analysis? 2. They have mentioned the location of different chondral/ osteochondral lesions encountered in the study, but they have not mentioned whether there was any difference in outcome between lesions in weight bearing and non-weight bearing parts of the joint surface. Did they find any such difference? If not, was there any difference in mobilisation protocol depending on location of the lesion (weight bearing/non-weight bearing)? 3. Were the procedures carried out arthroscopically or with an arthrotomy? If there were two separate groups, was there any difference between them? Arthroscopic techniques have been shown to improve the outcome compared to open technique.1 4. Did any of their patients have additional procedures, such as ACL reconstruction? If so, was it one stage or two stage? Combined one-stage ACL reconstruction with ACI has shown favourable results.2 5. Did they look at the effect of smoking on results? Smoking has been shown to affect healing of bone and other tissues.3 Was there any difference in the type of repair tissue at follow-up between smokers and non-smokers? H.V. Kurup, MS, MRCS, Specialist Registrar in Orthopaedics, Bangor, Wales, UK. 1. Erggelet C, Sittinger M, Lahm A. The arthroscopic implantation of autologous chondrocytes for the treatment of full-thickness cartilage defects of the knee joint. Arthroscopy 2003;19:108-10. 2. Klinger HM, Baums MH, Otte S, Steckel H. Anterior cruciate reconstruction combined with autologous osteochondral transplantation. Knee Surg Sports Traumatol Arthrosc 2003;11:366-71. 3. Hoogendoorn JM, Simmermacher RK, Schellekens PP, van der Werken C. Adverse effects of smoking on healing of bones and soft tissues. Unfallchirurg 2002;105:76-81.