Cartilage
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Demographics
As stated by the product insert for Carticel® there are no studies for the most recent, 3 years back, usage of ACI. Since, Carticel® has only been approved for knee implantation and usage of this device in the shoulders began in the year 2000 in the US and 2002 in Europe no randomized trials on shoulder ACI have been conducted. However, there have been trials concerning knee usage of this treatment:
According to Brittberg et al, 2003 (reference number), the percentage of improvement in patients who had received other previous shaving or microfracture operations was 89% compared to the 75% of patients without ACI. Also, the study includes results two to ten years after implantation of the patellar, trochlear, and multiple lesions giving 72%, 66%, and 76% subjective improvement of patients. This study shows the long term positive effects of ACI. This is just one of the many positive knee ACI trials that lead to the idea of using ACI in shoulders as well. In the future we can expect to see the same types of random trials performed with the usage of ACI in shoulder implantation.
Cost:
The cost of arthroscopic shaving is $15,000
The cost of ACI ranges from $17,000 to $35,000 according to Genzyme financial reporting on Carticel.
Therefore we can see that for an athlete that could potentially endure many arthroscopic shaving (the average is 3 reoperations according to Brittberg et al) the usage of one ACI treatment would be financially more beneficial.
This report from the Genzyme trials on Carticel shows that after ACI treatment there is a significant increase in patient results according to surgeons.
Results Two to Ten Years After Autologous Chondrocyte Transplantation for Lesions of the Femoral Condyle or Osteochondritis Dissecans
Previous Operations |
Percentage with Subjective/Objective Improvement |
Excellent |
Good |
Fair |
Poor |
58 in 29 patients |
89%/89.5% |
33 |
18 |
4 |
2 |
96 in 48 patients |
91%/93% |
31 |
22 |
4 |
1 |
55 in 27 patients |
63%, 85%/74% |
9 |
11 |
6 |
1 |
Results Two to Ten Years After Autologous Chondrocyte Transplantation for Patellar, Multiple, and Trochlear Lesions
Lesion |
No. |
Percentage with Subjective Improvement |
Excellent |
Good |
Fair |
Poor |
Patella |
32 |
72% |
8 |
14 |
4 |
6 |
Multiple |
58 |
76% |
17 |
27 |
11 |
3 |
Trochlear |
12 |
66% |
2 |
5 |
5 |
0 |
For more information visit: www.biomed. brown .edu/Courses/BI108/BI108_1999_Groups/ Cartilage_Team/
Created by: Blair Smith, Connie Lee, Daniel Solomon, Matthew Whitson, and Stephanie Chang
Date last modified: 5/2/2004