Use of a type I/III bilayer collagen membrane decreases reoperation rates for symptomatic hypertrophy after autologous chondrocyte implantation

Am J Sports Med. 2009 Nov:37 Suppl 1:20S-23S. doi: 10.1177/0363546509348477. Epub 2009 Oct 19.

Abstract

Background: Autologous chondrocyte implantation is associated with a high rate of reoperation, mostly due to hypertrophy of the periosteal patch. European studies investigating the use of collagen membranes as a periosteal substitute report significant decreases in reoperation rates to less than 5%. This multicenter study investigates the off-label use of 1 collagen membrane as a periosteal substitute for autologous chondrocyte implantation.

Hypothesis: The use of a collagen membrane for autologous chondrocyte implantation will decrease reoperation rates for hypertrophy with comparable rates of failure.

Study design: Cohort study; Level of evidence, 3.

Methods: A multicenter cohort of 300 patients treated with periosteal-covered autologous chondrocyte implantation was compared with a consecutive series of 101 patients who underwent collagen membrane-covered autologous chondrocyte implantation with the Bio-Gide membrane by the same group of surgeons. The 1-year hypertrophy-related reoperation rates and overall failure rates of autologous chondrocyte implantation were evaluated in both groups.

Results: Both groups were comparable for age (periosteal autologous chondrocyte implantation, 31.9 years; collagen autologous chondrocyte implantation, 32.4 years; P = .8) and average defect size (4.6 cm(2) and 4.7 cm(2), respectively; P = .7). The average number of defects (1.5 and 1.8; P = .001) and total defect area per knee (6.7 cm(2) and 8.6 cm(2); P = .003) were larger in the collagen membrane group. Within 1 year of surgery, 25.7% of patients treated with periosteal-covered autologous chondrocyte implantation required reoperation for hypertrophy and 2.3% were considered to have failed their treatment with autologous chondrocyte implantation. In comparison, only 5% of patients required reoperation for hypertrophy after collagen membrane-covered autologous chondrocyte implantation, and 4% were considered treatment failures.

Conclusion: The use of a collagen membrane for autologous chondrocyte implantation decreased the reoperation rate for hypertrophy after autologous chondrocyte implantation from 25.7% to 5% (P < .0001). Overall 1-year failure rates were comparable between the groups (P = .2). Even though the use of a collagen membrane for autologous chondrocyte implantation constitutes an off-label indication, its application appears justified by the lower morbidity to patients and decreased cost to the health care system. A detailed discussion with the patient is required regarding the use of an off-label device.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Chondrocytes / transplantation*
  • Cohort Studies
  • Collagen Type I / therapeutic use*
  • Collagen Type III / therapeutic use*
  • Female
  • Graft Rejection
  • Humans
  • Hypertrophy / surgery*
  • Knee Joint / surgery
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Recovery of Function
  • Reoperation / statistics & numerical data
  • Transplantation, Autologous*
  • Young Adult

Substances

  • Collagen Type I
  • Collagen Type III