A Randomized Controlled Trial Comparing “Early” Versus “Late” Periosteal Patch Attachment to Knee Chondral Defects in Autologous Chondrocyte Implantation

Orfanos, Georgios; McCarthy, Helen Samantha; Williams, Michael; Dugard, Naomi; Gallacher, Peter Denis; Glover, Alexander William; Roberts, Sally; Wright, Karina Therese; Kuiper, Jan Herman

Abstract

Objective
Traditional autologous chondrocyte implantation (ACI) involves arthroscopically harvesting a cartilage biopsy (stage 1), followed by arthrotomy 3-4 weeks later to apply a periosteal patch and implant culture-expanded chondrocytes underneath (stage 2). This study aimed to determine if patch application during stage 1 rather than stage 2 improved clinical outcome.
Design
A randomised controlled trial was conducted from 1998-2001. Patients were randomised to receive either traditional ACI (control/late), or ACI with ‘early’ patch during stage 1 (intervention/early). Clinical outcome (Lysholm score) was assessed pre-operatively and annually post-operatively.
Results
Seventy-seven patients were recruited, with 40 patients randomised to the early and 37 to the late patch group. The overall mean pre-operative Lysholm score was 51.8 (range 11-89) and significantly improved by 11.1 points (95%CI 4.8 to 17.4) at mean 12.7 years (range 1.5-23.7) follow-up. Latest mean Lysholm scores for the early and late groups were 68.4 (95%CI 19 to 100) versus 56.7 (95%CI 18 to 98). Adjusted for covariate imbalances, no evidence was found for a difference between the groups (mean difference 8.5, 95%CI -5.2 to 22.2, p=0.22). Twenty-year survival until any reoperation or arthroplasty was 59.6%/82.1% for the early and 56.8%/69.5% for the late group, with no evidence for a difference.
Conclusion
ACI is an effective durable treatment for cartilage defects, with high levels of patient satisfaction and low failure rates. No evidence was found that applying the periosteal patch at the time of chondrocyte harvest improved long term Lysholm scores or survival until any reoperation or arthroplasty.

Citation

Orfanos, G., McCarthy, H. S., Williams, M., Dugard, N., Gallacher, P. D., Glover, A. W., …Kuiper, J. H. (2024). A Randomized Controlled Trial Comparing “Early” Versus “Late” Periosteal Patch Attachment to Knee Chondral Defects in Autologous Chondrocyte Implantation. Cartilage, https://doi.org/10.1177/19476035241279943

• Journal Article Type: Article
• Acceptance Date: Aug 6, 2024
• Online Publication Date: Oct 31, 2024
• Publication Date: Oct 31, 2024
• Deposit Date: Sep 16, 2024
• Journal: CARTILAGE
• Print ISSN: 1947-6035
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1177/19476035241279943
• Keywords: cartilage regeneration surgery, randomized controlled trial, cell therapy, timing of patch attachment, autologous chondrocyte implantation
• Public URL: https://keele-repository.worktribe.com/output/921412
• Publisher URL: www.sage.com
• Additional Information: The paper is now at the proof-setting stage