Recommendations and Treatment Outcomes for Patellofemoral Articular Cartilage Defects With Autologous Chondrocyte Implantation: Prospective Evaluation at Average 4-Year Follow-up (original) (raw)
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Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013
Purpose: To compare clinical outcomes of patients undergoing isolated patellofemoral autologous chondrocyte implantation (ACI) and ACI combined with patellofemoral realignment. Methods: A systematic review was performed by use of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines/checklist. We searched PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SportDiscus, and the Cochrane Central Register of Controlled Trials databases from 1946 through February 2012 to determine whether a difference exists in outcomes of combined ACI and osteotomy versus isolated ACI (minimum 2 years' follow-up). Studies were included only if outcomes were reported separately for both isolated ACI and combined ACI and osteotomy. All ACI generations were eligible for inclusion. Patellofemoral osteotomies eligible for inclusion were anteriorization, medialization, or anteromedialization. All patient-, limb-, and defect-specific characteristics were assessed. All reported clinical scores, radiographic and histologic outcomes, and complications/reoperations were analyzed. Risk of bias was assessed within all studies. Results: Eleven studies (10 Level III or IV evidence) (366 subjects) were included. Of the defects treated, 78% were located on the patella and 22% on the trochlea. The mean subject age was 33.3 years. Twenty-three percent of subjects underwent concomitant osteotomy. The mean length of follow-up was 4.2 years. Significant (P < .05) improvements in patients undergoing both isolated ACI and combined ACI and osteotomy for patellofemoral chondral defects were observed in all studies. Three studies directly compared isolated ACI and combined ACI and osteotomy, with significantly (P < .05) greater improvements shown in patients undergoing combined osteotomy and ACI (International Knee Documentation Committee subjective score, Lysholm score, Knee Injury and Osteoarthritis Outcome Score, Tegner score, modified Cincinnati score, Short Form 12 score, and Short Form 36 score). There was no significant difference between groups in the rate of postoperative complications overall. Conclusions: This review showed statistically significant improvements in patients undergoing both isolated ACI and ACI combined with osteotomy for patellofemoral chondral defects in all studies. When individual studies compared these 2 groups (3 studies), significantly greater improvements in multiple clinical outcomes in subjects undergoing ACI combined with osteotomy were observed. There was no significant difference in the rate of total complications between groups.
Autologous Chondrocyte Implantation in the Patella
The American Journal of Sports Medicine, 2014
Background:Cartilage defects in the patella are common, and a subset of patients does not respond to nonoperative measures. While most cartilage repair techniques have demonstrated good outcomes in the femoral condyles, the patellofemoral compartment poses special challenges.Hypothesis:Repair of patellar cartilage defects with autologous chondrocyte implantation (ACI) will provide lasting improvements in pain and function.Study Design:Case series; Level of evidence, 4.Methods:Patients were treated at 1 of 4 participating cartilage repair centers with ACI for cartilage defects in the patella; bipolar (patella + trochlea) defects were included as well. All patients were followed prospectively for at least 4 years with multiple patient-reported outcome instruments, including the International Knee Documentation Committee, Short Form–12, modified Cincinnati Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Knee Society scores. Treatment failure was define...
Knee Surgery, Sports Traumatology, Arthroscopy, 2009
The aim of this prospective observational study was to assess the 3-year clinical outcome of distal realignment and membrane-seeded autologous chondrocyte implantation (MACI Ò ) in selected patients with patellofemoral malalignment and large, isolated, patellar cartilage lesions. Twelve patients (14 knees; 6 females, 6 males; mean age 31 years) with Fulkerson type II patellofemoral malalignment (lateralized and tilted patella) and Outerbridge grade III-IV isolated patellar cartilage lesions were treated. All had tibial tuberosity and trochlear sulcus [20 mm on a preoperative CT scan and a cartilage defect [3 cm 2 . Patients with Outerbridge grade III-IV trochlear cartilage lesions, those with rheumatic, infective or neoplastic conditions, or ligament instability, diabetes or obesity and those aged [40 years were excluded. Followup was at 36 months. Patients were enrolled after diagnostic arthroscopy. Cartilage was harvested and sent for culture. After a mean period of 30 days (range 25-40) patients underwent transfer of the tibial tuberosity according to Fulkerson associated with a MACI procedure. Clinical assessment was performed with the Kujala, Lysholm, Tegner and Modified Cincinnati scores. The Patient Satisfaction Survey was administered at 36 months. Consistently improved knee function and activity levels were reflected by significantly increased Kujala, Lysholm, Tegner and Modified Cincinnati scores at 36 months. The significant clinical improvement support the value of associating distal realignment and autologous chondrocyte implantation in treating large, isolated, patellar cartilage lesions associated with patellofemoral malalignment.
The American Journal of Sports Medicine
Background: There are limited randomized controlled trials with long-term outcomes comparing autologous chondrocyte implantation (ACI) versus alternative forms of surgical cartilage management within the knee. Purpose: To determine at 5 years after surgery whether ACI was superior to alternative forms of cartilage management in patients after a failed previous treatment for chondral or osteochondral defects in the knee. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In total, 390 participants were randomly assigned to receive either ACI or alternative management. Patients aged 18 to 55 years with one or two symptomatic cartilage defects who had failed 1 previous therapeutic surgical procedure in excess of 6 months prior were included. Dual primary outcome measures were used: (1) patient-completed Lysholm knee score and (2) time from surgery to cessation of treatment benefit. Secondary outcome measures included International Knee Documentation Committee and...
Treatment of patellofemoralarticular cartilage injuries with autologous chondrocyte implantation
Operative Techniques in Sports Medicine, 2002
Autologous chondrocyte implantation (ACI) has successfully been used to repair chondral injuries of the knee. Articular cartilage defects of the patella and trochlea represent a class of cartilage lesions of the knee that have recently been considered an increasing indication for treatment with ACI. These lesions often differ from condyle lesions, having a different etiology and coexisting pathologic conditions in the knee associated with them. Patellar and trochlear cartilage lesions are often associated with patellofemoral maltracking. To obtain good results with these cartilage injuries with ACI, it is essential to address the underlying maltracking issues. Additionally, the contours of the patellar and trochlear cartilage differ from that of the condyles, requiring a modification in the standard technique of periosteal attachment used with condylar lesions. Although results of treating trochlear lesions with ACI have shown good results, the initial reports of treating patellar lesions with ACI were diminished compared to condylar lesions. Recognizing and treating the coexisting pathologic conditions and carefully modifying the standard technique of periosteal attachment has resulted in improved results.
Injury, 2017
Introduction: Autologous Chondrocyte Implantation (ACI) has been the first technique in reconstruction of a valid articular surface. The aim of this study was to evaluate clinical results of this technique at an average follow up of 162 AE 27 months (range 88-208) in a group of patients who underwent ACI. Materials and methods: 32 patients were operated between 1997 and 2007 for chondral lesions or osteochondritis dissecans of the knee. Mean size of the defect was 5.48 cm 2 AE 1.53 (range 2-9). Nine patients were treated with I generation technique and 23 with II generation. All patients were evaluated with Subjective IKDC and Tegner Activity Scales for clinical outcomes and with EQ-VAS for a quantitative measure of health after intervention, starting from pre-operative period and at regular follow up (minimum 88 months-maximum 208 months). Results: A significant increment of all scores was noticed comparing preoperative and postoperative results. In particular medium IKDC score increased from 40.3 AE 9.6 in preoperative evaluation to 74.2 AE 11.6 at one year (p < 0.00001) and to 83.9 AE 10.4 at 5 years follow up (p < 0.001). Mean IKDC values at the last follow-up were 80.3 AE 14.2, showing no statistical differences with those obtained at five-year follow-up. Tegner Activity Scale values increased from 2.8 AE 1.1 preoperatively to 4.1 AE1.1 (p < 0.0001) after one year and to 6 AE 1.1 at five years (p < 0.0001). Mean Tegner Activity Scale values decreased to 4.8 AE 1.4 at the last follow-up. EQ-VAS evaluation showed superposable results comparing the 5 years evaluation with the ones at a medium follow up of 162 AE 27 months. Discussion: The most important finding is the reliability at long-term of ACI technique, which in our series gave excellent clinical results. No statistical differences were observed between firstand secondgeneration. Clinical outcomes were significantly better for defects in the femoral condyles, influenced by age (worse results over 30 years old). Conclusions: ACI represents a valid technique for chondral and osteochondral lesions of the knee in a population heterogeneous for age, sex and activity level with good results even at a long term follow up.
Autologous Chondrocyte Implantation for Focal Chondral Defects of the Knee
Clinical Orthopaedics and Related Research, 2001
Autologous chondrocyte implantation has been used since March 1995 in a prospective cohort evaluation. One hundred sixty-nine patients, 13 to 58 years, have been treated as of December 1999. One hundred seven patients have greater than 12 months followup, and 56 have greater than 24 months followup. Overall 87% of patients improved. Patient assessment instruments include the modified Cincinnati knee rating scale, Short Form-36, Knee Society score, Western Ontario McMaster Universities Osteoarthritis Index score, and patient satisfaction survey. Treatment cases included the following categories: Simple (N ؍ 12) isolated femoral condyles; Complex (N ؍ 86) nonarthritic knees with multiple defects on the femur, or isolated lesions to the patella or tibia; and Salvage (N ؍ 71) knees with early arthritic changes. The areas treated were large: Simple, 4.3 cm 2 (one defect); Complex, 6.75 cm 2 (4.5 cm 2 per defect ؋ 1.5 defects per case), and Salvage, 11.66 cm 2 (5.3 cm 2 per defect ؋ 2.2 defects per case). Patients who had complex and salvage treatments (N ؍ 107) with greater than 1 year followup frequently had adjuvant treatments including valgus tibial (N ؍ 24) or tibial tubercle (N ϭ 15) osteotomies or ligament reconstruction (N ؍ 5). At the 2-year followup, statistically significant functional improvements occurred in the patients in the Simple and Complex categories (Cincinnati score; Simple, baseline 3.57, 24 months ؍ 5.38; Complex, baseline 3.40, 24 months ؍ 6.06;). Patients in the Salvage category had statistically significant improvement in Short Form-36 quality of life scores (Physical summary, 24 months) and an increase in the Cincinnati rating scale when the patellofemoral joint was not involved. Patient satisfaction at 24 months for Simple, Complex, and Salvage categories was 60%, 70%, and 90%, respectively. There were 22 failures in 169 patients treated (13%), which was defined as no clinical improvement or graft failure.
The Bone & Joint Journal, 2012
Autologous chondrocyte implantation (ACI) and mosaicplasty are methods of treating symptomatic articular cartilage defects in the knee. This study represents the first long-term randomised comparison of the two techniques in 100 patients at a minimum follow-up of ten years. The mean age of the patients at the time of surgery was 31.3 years (16 to 49); the mean duration of symptoms pre-operatively was 7.2 years (9 months to 20 years). The lesions were large with the mean size for the ACI group being 440.9 mm2 (100 to 1050) and the mosaicplasty group being 399.6 mm2 (100 to 2000). Patients had a mean of 1.5 previous operations (0 to 4) to the articular cartilage defect. Patients were assessed using the modified Cincinnati knee score and the Stanmore-Bentley Functional Rating system. The number of patients whose repair had failed at ten years was ten of 58 (17%) in the ACI group and 23 of 42 (55%) in the mosaicplasty group (p < 0.001). The functional outcome of those patients with a...