Summary

No difference in outcomes between coblation and mechanical chondroplasty in patients undergoing autologous chondrocyte implantation (ACI)

Abstract

Introduction

Autologous chondrocyte implantation (ACI) serves as a common surgical intervention to treat osteochondral injury, particularly in younger patients with larger defect size. During the initial stage of this procedure, cartilage biopsy is typically performed alongside chondroplasty, which is traditionally performed with an arthroscopic shaver. More recently, coblation devices have emerged as an option for chondroplasty. Studies have demonstrated its efficacy and safety in the use of chondroplasty within the knee, but its use concomitantly during ACI has not yet been studied. The aim of this study was to investigate differences in reoperation rate, return to activity and failure between mechanical chondroplasty and coblation.

Methods

A retrospective chart review from 2010 to 2022 identified patients who underwent ACI in addition to mechanical chondroplasty or radiofrequency ablation. Patient demographics, cartilage defect location and size, and outcome metrics were collected. Data were checked for normality with a Shapiro-Wilk test prior to statistical analysis. Group differences were assessed with t-tests or Mann-Whitney U tests. Fisher Exact test or Chi-Square tests were performed to analyze the association between categorical variables. Significance was set at p < 0.05 and all statistical analyses were performed with SYSTAT (version 13.1, Chicago, IL).

Results

95 patients met inclusion criteria. Of these, 84 patients received mechanical chondroplasty and 21 received radiofrequency ablation. The mechanical chondroplasty cohort included 43 males (50.5%), and mean BMI of 27.15 kg/m2, while the coblation group had 11 males (52.4%) and had a mean BMI of 29.14 kg/m2. No statistical differences between groups were found in patient or defect demographic data (p>0.05). Return to activity was 85.9% vs. 66.7% (p=0.056) with a mean time to return to activity of 377 days vs. 503 days (p=0.385) in the mechanical group and coblation groups respectively. Reoperation rates were 31.8% and 33.3% between mechanical and coblation chondroplasty, respectively (p=0.128). Finally, a failure rate of 18.8% in the mechanical group and 28.6% in the coblation group was shown (p=0.370). No statistically significant differences were found between groups across any outcomes data.

Conclusion

There was no significant difference between outcomes of reoperation, failure rate and return to activity between mechanical and coblation chondroplasty in the context of concomittant ACI surgery.