Dugard, MN, Kuiper, JH, Parker, J, Roberts, S, Robinson, E, Harrison, P and Richardson, JB (2016) Development of a tool to predict outcome of Autologous Chondrocyte Implantation. Cartilage, 8 (2). pp. 119-130. ISSN 1947-6043

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Objective. The study had 2 objectives: first, to evaluate the success of autologous chondrocyte implantation (ACI) in
terms of incidence of surgical re-intervention, including arthroplasty, and investigate predictors of successful treatment
outcome. The second objective was to derive a tool predicting a patient’s arthroplasty risk following ACI. Design. In this
Level II, prognostic study, 170 ACI-treated patients (110 males [aged 36.8 ± 9.4 years]; 60 females [aged 38.1 ± 10.2
years]) completed a questionnaire about further surgery on their knee treated with ACI 10.9 ± 3.5 years previously.
Factors commonly assessed preoperatively (age, gender, defect location and number, previous surgery at this site, and the
preoperative Lysholm score) were used as independent factors in regression analyses. Results. At final follow-up (maximum
of 19 years post-ACI), 40 patients (23.5%) had undergone surgical re-intervention following ACI. Twenty-six patients
(15.3%) underwent arthroplasty, more commonly females (25%) than males (10%; P = 0.001). Cox regression analyses
identified 4 factors associated with re-intervention: age at ACI, multiple operations before ACI, patellar defects, and lower
pretreatment Lysholm scores (Nagelkerke’s R2
= 0.20). Six predictive items associated with risk of arthroplasty following
ACI (Nagelkerke’s R2
= 0.34) were used to develop the Oswestry Risk of Knee Arthroplasty index with internal crossvalidation. Conclusion. In a single-center study, we have identified 6 factors (age, gender, location and number of defects,
number of previous operations, and Lysholm score before ACI) that appear to influence the likelihood of ACI patients
progressing to arthroplasty. We have used this information to propose a formula or “tool” that could aid treatment
decisions and improve patient selection for ACI.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Sage at https://doi.org/10.1177%2F1947603516650002 Please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: prediction tool; success of ACI; further surgery; cartilage repair
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 08 Sep 2016 09:49
Last Modified: 11 Mar 2021 11:32
URI: https://eprints.keele.ac.uk/id/eprint/2152

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