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Factors affecting outcome after autologous chondrocyte implantation for the treatment of osteochondral defects of the knee

Jaiswal, PK; (2015) Factors affecting outcome after autologous chondrocyte implantation for the treatment of osteochondral defects of the knee. Doctoral thesis , UCL (University College London). Green open access

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Abstract

Some studies on autologous chondrocyte implantation (ACI) have demonstrated little benefit over other techniques and few have demonstrated a lasting benefit. A number of factors can contribute to failure and a scientific approach to elucidate these variables has not been reported. This thesis reports on the use of a statistical approach - the Generalised Linear Model (GLM) to quantify the effect each factor has whilst considering the interplay of other variables. Data from a randomised controlled trial and several case-controlled studies will assess the efficacy of 2 different types of ACI, the influence of smoking, BMI, and physical activity. Non-modifiable risk factors that were assessed include the aetiology, site and size of the lesion, the duration of symptoms and number of previous operations prior to the index procedure and the presence of early osteoarthritis. Site had a significant effect on outcome but size did not. The GLM predicted a point increase in the Modified Cincinnati Score (MCS) before surgery (MCS 0) would lead to a further 0.5 point increase in MCS 2 years postoperatively (MCS 24) (p=0.001). Other significant non-modifiable risk factors include age and sex of the patient. When treating lesions in the patella, duration of symptoms was a significant factor, but age was not. The GLM predicted that smokers’ MCS 24 (the Modified Cincinnati Score 2 years after surgery) was likely to be 15 less than non-smokers (p=0.002). Patients playing no sports experienced an 11.4 point decrease. For each increase in BMI, the MCS 24 was 2.4 less (p=0.001). Factors that optimise outcome following surgery are; avoidance of numerous procedures prior to ACI and delay of more than one year before undergoing ACI. Current NICE guidelines prohibit the use of ACI as the first-line surgical procedure and prevent addressing the above 2 issues. Poorer results were observed in obese patients. Weight loss and active lifestyle are essential pre-operatively. Furthermore, we recommend that pre-operative counselling for smokers is essential and that all smokers be offered a cessation programme.

Type: Thesis (Doctoral)
Title: Factors affecting outcome after autologous chondrocyte implantation for the treatment of osteochondral defects of the knee
Open access status: An open access version is available from UCL Discovery
Language: English
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
URI: https://discovery.ucl.ac.uk/id/eprint/1467124
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