Evidence of inappropriate application of autologous cartilage transplantation therapy in an uncontrolled environment

Autologous chondrocyte transplantation is a new procedure developed for the treatment of focal articular cartilage defects of the knee. The exact indi cations and limitations of this procedure have not yet been completely defi ned through prospective, randomized studies. The purpose of this study was to examine the indications and contraindications for surgery in consecutive cases initially rejected for reimbursement of surgical expenses by insuran ce companies, but now on appeal, to assess whether patients referred by the physicians met the procedure criteria. Twenty-four consecutive candidates were referred for adjudication when the recommending orthopaedic surgeon ap pealed a rejection by a medical reviewer. The factors examined included the number and size of the cartilage lesions, the presence of tricompartmental arthritis, transplantation proposed for patellar lesions, patient age, and sagittal plane deformity. In 23 of 24 cases (96%) the indications for the procedure were not met or specific contraindications were present. In 15 of 24 cases (63%) there were multiple contraindications. The results of this study underscore the importance of controlled, application-limited experien ce before the release of new procedures for widespread clinical application s. The uncontrolled use of this procedure may negatively skew the overall r esults for this technique, prejudicing a procedure that may be successful f or the correct indications.