2015 ISAKOS Biennial Congress ePoster #410

Additional Surgical Procedure Rate After Use of a Bilayer Collagen Membrane in Autologous Chondrocyte Implantation

Samuel Tabet, MD, Albuquerque, NM UNITED STATES
Loren M. James, MD, Alabaster, AL UNITED STATES
New Mexico Orthopaedics, Albuquerque, New Mexico, USA

FDA Status Not Applicable

Summary: This study investigates replacing a periosteal based procedure with a 1 collagen membrane in autologous chondrocyte implantation.

Abstract:

Introduction

Autologous chondrocyte implantation(ACI) has high reoperation rates mainly due to periosteal patch hypertrophy. Investigations into using collagen membranes as a periosteal substitute have been performed. Reoperation rates to 5% or less have been reported in American and European studies. Our study investigates replacing a periosteal based procedure with 1 collagen membrane.

Methods

A single center cohort of 53 patients treated with periosteal-covering was compared with a consecutive series of 34 patients undergoing implantation with collagen (Bio-Gide membrane) by a single surgeon. The overall 1 and 2 year second surgical procedure rates were evaluated for the Bio-Gide group and the overall second procedure rates were compared between groups.

Results

34.0% treated with periosteum required reoperation (minimum 1 year follow-up). 17.6% required a second procedure (minimum 2 years follow-up) in the collagen group (no statistical significance) compared with 11.8% at one year. For periosteum, 24.5% demonstrated graft hypertrophy on second look compared to 2.9% in collagen (statistically significant p=0.0075). For collagen, adhesions were the main cause of reoperation. 17.6% required manipulation and/or lysis. For periosteum, 15.1% had adhesions.

Discussion And Conclusion

Second procedure rates decreased in collagen membrane implantation compared to periosteal implantation (17.6% vs. 34%) although the sample size was too small to detect a significant difference. Previous studies providing one year follow-up may be underestimating second procedure rates with collagen (2 year - 17.6% vs. 1 year - 11.8%). The results support that collagen decreases the rate of second procedures related to hypertrophy compared to periosteum (2.9% vs. 24.5%). Rates secondary to adhesions were similar (17.6% vs. 15.1%).