To The Editor:We read with interest the article "Autologous Cultured Chondrocytes:
Adverse Events Reported to the United States Food and Drug
Administration" (2006;88:503-7), by Wood et al. While the authors did
allude to some of the limitations of passive reporting systems, we felt that
they warrant further emphasis.In the paper, it is not clear what the pretransplantation selection
criteria for the patients were. At present, most centers use the technique for
isolated osteochondral defects and consider any evidence of degenerative
changes in the joint as a contraindication. Also, to prevent recurrent
chondral injury, a careful evaluation for predisposing factors or concomitant
injuries must be undertaken. Minas and Nehrer13 reported in their
review that any tibiofemoral malalignment, ligamentous instability, or bone
insufficiency must be corrected prior to, or at the time of, cartilage repair.
For example, rupture or laxity of the anterior cruciate ligament may result in
abnormal translation and rotation of the femur on the tibia and shearing of
the chondrocyte graft. Thus, proper patient selection is crucial to the
success of this procedure, and it is not a "one size fits all"