Chondrocyte Implantation in the Repair of Chondral Lesions of the Knee: Economics and Quality of Life
abstract & commentary
Synopsis: Cartilage cell implantation improves patient quality of life and is an appropriate, cost-effective treatment for cartilage lesions of the knee.
Source: Minas T. Chondrocyte implantation in the repair of chondral lesions of the knee: Economics and quality of life. Am J Orthop 1998;27(11):739-744.
Minas presents some of the economic issues associated with autologous chondrocyte implantation (ACI), one of several available techniques used by orthopedists to restore hyaline cartilage in areas of full thickness articular cartilage loss. He estimates that the cost for this procedure per additional quality-adjusted year of life is $6791, a cost he believes is comparable to other therapies for chronic illnesses. Direct in-hospital costs for this procedure ranged from $17,607 to $38,400, including facility and physician charges for the initial biopsy procedure and the subsequent implantation surgery.
Comment by Letha Y. Griffin, MD, PhD
In the past, cartilage abrasion or abrasion with drilling of the subchondral bone has been done to treat areas of articular cartilage loss, but these techniques result in the development of fibrocartilage rather than hyaline cartilage. Stone and Walgenback have developed a technique reported to enhance hyaline-like cartilage development in knees by adding to drilled areas growth factors delivered as a "paste" of morelized hyaline cartilage taken from the non-weight-bearing notch area.1
Others, such as Hangody and colleagues2 and Bobic,3 have developed techniques to graft hyaline cartilage defects occurring in young active individuals with autologous bone plugs harvested from either the femoral notch or the lateral trochlear border. The technique of autologous cell implantation is the most expensive of the procedures available to try to fill hyaline cartilage defects in young, active people. Advocates of ACI feel that of all the procedures presently used, it alone truly results in new autologous type II cartilage.4 Minas reports "a success rate of over 80%." However, not only does this technique require two operative procedures, the second of which is done open rather than arthroscopically, it also necessitates growing cells harvested during the initial procedure in tissue culture to obtain a sufficient quantity of cells for grafting to the area of cartilage loss; therefore, it is not ideal. Looking to the future, one hopes that scientists will soon be able to recommend the proper combination of growth factors mixed with the appropriate collagen scaffold that will, when added to mesenchymal cells derived from drilling of articular cartilage defects, result in true hyaline cartilage healing.
References
1. Stone K, Walgenback A. Surgical technique for articular cartilage transplantation to full-thickness cartilage defects in the knee joint. Operative Techniques in Orthopaedics 1997;7(4):305-311.
2. Hangody L, et al. Osteochondral plugs: Autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral articular defects. Operative Techniques in Orthopaedics 1997;7(4):312-322.
3. Bobic V. Arthroscopic osteochondral autograft transplantation in anteriour cruciate ligament reconstruction: A preliminary clinical study. J Bone Joint Surg Br 1966;78:Suppl I,59.
4. Minas T, Nehrer S. The treatment of articular cartilage defects. Orthopaedics 1997;20(6):525-538.
42. An appropriate technique used to treat less than 2 cm hyalin cartilage defects in the knees of young athletic individuals is:
a. chondrocyte transplantation.
b. abrasion and drilling.
c. abrasion, drilling followed by "pasting" the area with
autologous, morelized hyaline cartilage.
d. autologous bone plugs.
e. All of the above
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