Background:

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.

Purpose:

To assess the 5-year incidence, timing, and risk factors for revision surgery after ACI in a large national cohort.

Study Design:

Case series; Level of evidence, 4.

Methods:

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.

Results:

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; P = .013) and BMI ≥35 (odds ratio, 2.24; 95% CI, 1.01-4.94; P = .047). There was no relationship between age, ECI score, or previous or concomitant bony realignment procedures and revision surgery at 5 years (P > .05).

Conclusion:

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.

中文翻译：

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533 例自体软骨细胞植入后 5 年翻修手术的发生率、时机和风险因素

背景：

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、时间和风险因素的大样本证据有限。

目的：

在一个大型国家队列中评估 ACI 后翻修手术的 5 年发病率、时机和风险因素。

学习规划：

案例系列；证据水平，4。

方法：

查询了 2010-2020 年 PearlDiver 数据库中年龄在 20 至 59 岁之间接受过原发性膝关节 ACI 且既往未进行过软骨手术或膝关节置换术的患者。翻修手术被定义为5年内的后续翻修ACI、同种异体骨软骨移植、自体骨软骨移植、单髁膝关节置换术或全膝关节置换术。Kaplan-Meier 分析用于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，以及之前或同时进行的骨重整手术。

结果：

总共有 533 名患者接受了原发性 ACI 并符合纳入标准。翻修手术的 5 年发生率为 10.3%，其中 63% 的翻修发生在术后前 2 年。与翻修手术相关的危险因素包括女性（优势比，2.58；95% CI，1.22-5.45；P = .013）和 BMI ≥35（优势比，2.24；95% CI，1.01-4.94；P = .047 ） ）。5 年时，年龄、ECI 评分、既往或同时进行的骨重整手术与翻修手术之间没有关系（P > .05）。

结论：

在对 533 名接受 ACI 的患者的分析中，10.3% 的患者需要在术后前 5 年内进行后续关节软骨手术或转为膝关节置换术。术后前 2 年的翻修手术最多。女性和重度肥胖（BMI，≥35）与翻修手术风险增加相关，而年龄、ECI 评分以及既往或同时进行的骨重整手术则与此无关。这些发现表明，用 ACI 治疗膝关节软骨缺损与 5 年随访的持久结果相关。