Saturday, December 29, 2012

Another Study That Says ACI Isn’t as Good as Advertised

Autologous chondrocyte implantation, as I described in Saving My Knees, is an extensive procedure: harvest good chondrocytes from your knee, grow hundreds of thousands more of them in a lab, then fill the holes in your cartilage with the cultured tissue.

A while ago, I came across a study of the surgery suggesting that its benefits may fall short of what’s advertised. (More than a year ago, some of you may recall, I looked at ACI vs. microfracture, and which is better.)

Here’s the study if you want to peruse it yourself. If you’re thinking of undergoing ACI, take a look at the graphic color photos. This isn’t “keyhole” type surgery. ACI is a major operation.

This particular study followed 19 patients, average age 32, who were professional soldiers and athletes -- and who thus put high physical demands on their knee joints. This was a hard-luck group to begin with: all but two had had either a microfracture or a “clean up” of their ragged cartilage.

After having the ACI performed, 11 of the 19 (more than half) underwent “second-look arthroscopy” because of “persistent pain, decreased range of movements, and mechanical symptoms.” (Which tends to support my belief that, unfortunately, surgery often begets surgery.)

The results? Well, the authors of the research note that previous studies have found ACI to have a success rate of up to 90 percent -- pretty impressive. In this study, however, only 31%, or 1 in 3 subjects, “returned to prior levels of athletic performance.”

The conclusion was that “in high-demand patients who have a longstanding disability, large defects, and failed previous cartilage techniques, the results of autologous chondrocyte implantation may not be as good as those reported or expected.”

That should give those pondering ACI, or even a lesser surgery, something to mull over.

Surgery is sometimes very successful. You’ll find people who come out the other side of the operating room wishing they had done it earlier.

But it’s never a slam dunk of a decision. It’s not to be taken lightly. In particular, listen to your doctor when he says after assessing your bad knee, “I wouldn’t advise surgery for you right now.” Because this is someone who has an economic incentive for performing surgeries -- if he opposes it, that should tell you something.

I’d never advise anyone to have surgery or not to have surgery. However, I would say it’s never a bad idea to think twice about it, and to make sure you’ve exhausted other options.

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