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Comparative Study
. 2021 Dec;13(1_suppl):1187S-1194S.
doi: 10.1177/1947603520967065. Epub 2020 Oct 27.

Comparison of Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation of the Knee in a Large Insurance Database: Reoperation Rate, Complications, and Cost Analysis

Kyle R Sochacki  1 , Kunal Varshneya  1 , Jacob G Calcei  1 , Marc R Safran  1 , Geoffrey D Abrams  1 , Joseph Donahue  1 , Constance Chu  1 , Seth L Sherman  1
Affiliations
Comparative Study

Comparison of Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation of the Knee in a Large Insurance Database: Reoperation Rate, Complications, and Cost Analysis

Kyle R Sochacki et al. Cartilage. 2021 Dec.

Abstract

Objective: To compare (1) the reoperation rates, (2) risk factors for reoperation, (3) 30-day complication rates, and (4) cost differences between autologous chondrocyte implantation (ACI) and osteochondral allograft transplantation (OCA) of the knee in a large insurance database.

Design: Subjects who underwent knee ACI (Current Procedural Terminology [CPT] code 27412) or OCA (CPT code 27415) with minimum 2-year follow-up were queried from a national insurance database. Reoperation was defined by ipsilateral knee procedure after index surgery. Multivariate logistic regression models were built to determine the effect of independent variables (age, sex, tobacco use, obesity, diabetes, and concomitant osteotomy) on reoperation rates. The 30-day complication rates were assessed using ICD-9-CM codes. The cost of the procedures per patient was calculated. Statistical comparisons were made. All P values were reported with significance set at P < 0.05.

Results: A total of 909 subjects (315 ACI and 594 OCA) were included (mean follow-up 39.2 months). There was a significantly higher reoperation rate after index ACI compared with OCA (67.6% vs. 40.4%, P < 0.0001). Concomitant osteotomy at the time of index procedure significantly reduced the risk for reoperation in both groups (odds ratio [OR] 0.2, P < 0.0001 and OR 0.2, P = 0.009). The complication rates were similar between ACI (1.6%) and OCA (1.2%) groups (P = 0.24). Day of surgery payments were significantly higher after ACI compared with OCA (P = 0.013).

Conclusions: Autologous chondrocyte implantation had significantly higher reoperation rates and cost with similar complication rates compared with OCA. Concomitant osteotomy significantly reduced the risk for reoperation in both groups.

Keywords: autologous chondrocyte implantation; osteochondral allograft; osteotomy; reoperations.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Marc R. Safran has the following disclosures: American Journal of Sports Medicine: Editorial or governing board; Biomimedica: Stock or stock Options; Unpaid consultant; DJ Orthopaedics: IP royalties; International Society for Hip Arthroscopy: Board or committee member; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: Board or committee member; JISAKOS: Editorial or governing board; Journal of Hip Preservation Surgery: Editorial or governing board; Medacta: Paid consultant; Paid presenter or speaker; Saunders/Mosby-Elsevier: Publishing royalties, financial or material support; Smith & Nephew: IP royalties; Paid presenter or speaker; Research support; paid consultant; Stryker: IP royalties; Wolters Kluwer Health–Lippincott Williams & Wilkins: Publishing royalties, financial or material support; consulting fees from Anika Therapeutics, Linvatec; Linvatec: paid speaker. Geoffrey D. Abrams has the following disclosures: AAOS: Board or committee member; American Orthopaedic Society for Sports Medicine: Board or committee member; Arthrex, Inc: Other financial or material support, educational support; Cytonics Inc.: Paid consultant; Stock or stock Options; Fidia Pharma: Paid consultant; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: Board or committee member; RubiconMD: Paid consultant; Sideline Sports Doc: Paid consultant; Stryker: educational support; TeachAIDS: Unpaid consultant; Evolution Surgical: educational support; Consulting fees from Cytonics, Fidia Pharma, RubiconMD, and Sideline Sports Doc. Joseph Donahue has the following disclosures: Stabilynx: Stock or stock options; educational support from Arthrex, consulting fees from DePuy Synthes and Medical Device Business Systems, hospitality payments from Evolution Surgical. Constance Chu has the following disclosures: Honoraria from Fidia Pharma. Seth L. Sherman has the following disclosures: ACL Study Group: Board or committee member; American Journal of Orthopedics: Editorial or governing board; American Orthopaedic Society for Sports Medicine: Board or committee member; Arthrex, Inc: Paid consultant, nonconsulting fees; Research support; Arthroscopy: Editorial or governing board; Arthroscopy Association of North America: Board or committee member; Ceterix Orthopaedics: Paid consultant; CONMED Linvatec: Paid consultant; Flexion Therapeutics: Paid consultant; GLG Consulting: Paid consultant; International Cartilage Regeneration & Joint Preservation Society: Board or committee member; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: Board or committee member; JRF Ortho: Paid consultant; Moximed: Paid consultant; Olympus: Paid consultant; Vericel: Paid consultant, nonconsulting fees, honoraria; RTI surgical: Paid consultant; DJO: grant; Elite Orthopedics: Educational support. Kyle R. Sochacki, Kunal Varshneya, and Jacob G. Calcei declare no potential conflicts of interest.

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