Second Generation Autologous Chondrocyte Implantation in Patellofemoral Full-Thickness Chondral Defects: A Clinical, Arthroscopic, and Histologic Review at Five-Year Follow-up (SS-19)

Objective To determine the relationship between cartilage lesion etiology and clinical outcomes after second-generation autologous chondrocyte implantation (ACI) in the patellofemoral joint (PFJ) with a minimum of 2 years’ follow-up. Methods A retrospective review of all patients that underwent ACI in the PFJ by a single surgeon was performed. Seventy-two patients with a mean follow-up of 4.2 ± 2.0 years were enrolled in this study and were stratified into 3 groups based on the etiology of PFJ cartilage lesions: patellar dislocation (group 1; n = 23); nontraumatic lesions, including chondromalacia, osteochondritis dissecans, and degenerative defects (group 2; n = 28); and other posttraumatic lesions besides patellar dislocations (group 3; n = 21). Patient’s mean age was 29.6 ± 8.7 years. Patients in group 1 were significantly younger (25.4 ± 7.9 years) than group 2 (31.7 ± 9.6 years; P = 0.025) and group 3 (31.5 ± 6.6 years; P = 0.05). Body mass index averaged 26.2 ± 4.3 kg/m2, with a significant difference between group 1 (24.4 ± 3.2 kg/m2) and group 3 (28.7 ± 4.5 kg/m2; P = 0.005). A clinical comparison was established between groups based on patient-reported outcome measures (PROMs) and failure rates. Results Neither pre- nor postoperative PROMs differed between groups ( P > 0.05). No difference was seen in survivorship between groups (95.7% vs. 82.2% vs. 90.5%, P > 0.05). Conclusion Cartilage lesion etiology did not influence clinical outcome in this retrospective study after second generation ACI in the PFJ. Level of Evidence Level III, retrospective comparative study.

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Sporting participation following the operative management of chondral defects of the knee at mid-term follow up: a systematic review and meta-analysis

Journal of Experimental Orthopaedics ◽

10.1186/s40634-020-00295-x ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

P. G. Robinson ◽

T. Williamson ◽

I. R. Murray ◽

K. Al-Hourani ◽

T. O. White

Keyword(s):

Systematic Review ◽

Autologous Chondrocyte Implantation ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Osteochondral Allograft ◽

Chondral Defects ◽

Chondrocyte Implantation ◽

The Mean ◽

Autologous Chondrocyte

Abstract Purpose The purpose of this study was to perform a systematic review of the reparticipation in sport at mid-term follow up in athletes who underwent biologic treatment of chondral defects in the knee and compare the rates amongst different biologic procedures. Methods A search of PubMed/Medline and Embase was performed in May 2020 in keeping with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The criteria for inclusion were observational, published research articles studying the outcomes and rates of participation in sport following biologic treatments of the knee with a minimum mean/median follow up of 5 years. Interventions included microfracture, osteochondral autograft transfer (OAT), autologous chondrocyte implantation (ACI), matrix-induced autologous chondrocyte implantation (MACI), osteochondral allograft, or platelet rich plasma (PRP) and peripheral blood stem cells (PBSC). A random effects model of head-to-head evidence was used to determine rates of sporting participation following each intervention. Results There were twenty-nine studies which met the inclusion criteria with a total of 1276 patients (67% male, 33% female). The mean age was 32.8 years (13–69, SD 5.7) and the mean follow up was 89 months (SD 42.4). The number of studies reporting OAT was 8 (27.6%), ACI was 6 (20.7%), MACI was 7 (24.1%), microfracture was 5 (17.2%), osteochondral allograft was 4 (13.8%), and one study (3.4%) reported on PRP and PBSC. The overall return to any level of sport was 80%, with 58.6% returning to preinjury levels. PRP and PBSC (100%) and OAT (84.4%) had the highest rates of sporting participation, followed by allograft (83.9%) and ACI (80.7%). The lowest rates of participation were seen following MACI (74%) and microfracture (64.2%). Conclusions High rates of re-participation in sport are sustained for at least 5 years following biologic intervention for chondral injuries in the knee. Where possible, OAT should be considered as the treatment of choice when prolonged participation in sport is a priority for patients. However, MACI may achieve the highest probability of returning to the same pre-injury sporting level. Level of evidence IV

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Intermediate- to Long-Term Results of Combined Anterior Cruciate Ligament Reconstruction and Autologous Chondrocyte Implantation

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117693591 ◽

2017 ◽

Vol 5 (2) ◽

pp. 232596711769359 ◽

Cited By ~ 5

Author(s):

Andrew N. Pike ◽

Tim Bryant ◽

Takahiro Ogura ◽

Tom Minas

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Autologous Chondrocyte Implantation ◽

Cruciate Ligament ◽

Chondral Defects ◽

Chondrocyte Implantation ◽

Anterior Cruciate ◽

Autologous Chondrocyte

Background: Cartilage injury associated with anterior cruciate ligament (ACL) ruptures is common; however, relatively few reports exist on concurrent cartilage repair with ACL reconstruction. Autologous chondrocyte implantation (ACI) has been utilized successfully for treatment of moderate to large chondral defects. Hypothesis: ACL insufficiency with relatively large chondral defects may be effectively managed with concurrent ACL reconstruction and ACI. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing concurrent ACL primary or revision reconstruction with ACI of single or multiple cartilage defects were prospectively evaluated for a minimum 2 years. Pre- and postoperative outcome measures included the modified Cincinnati Rating Scale (MCRS), Western Ontario and McMaster Universities Osteoarthritis Index, visual analog pain scales, and postsurgery satisfaction surveys. ACI graft failure or persistent pain without functional improvement were considered treatment failures. Results: Twenty-six patients were included, with 13 primary and 13 revision ACL reconstructions performed. Mean defect total surface area was 8.4 cm2, with a mean follow-up of 95 months (range, 24-240 months). MCRS improved from 3.62 ± 1.42 to 5.54 ± 2.32, Western Ontario and McMaster Universities Osteoarthritis Index from 45.31 ± 17.27 to 26.54 ± 17.71, and visual analog pain scale from 6.19 ± 1.27 to 3.65 ± 1.77 (all Ps <.001). Eight patients were clinical failures, 69% of patients were improved at final follow-up, and 92% stated they would likely undergo the procedure again. No outcome correlation was found with regard to age, body mass index, sex, defect size/number, follow-up time, or primary versus revision ACL reconstruction. In subanalysis, revision ACL reconstructions had worse preoperative MCRS scores and greater defect surface areas. However, revision MCRS score improvements were greater, resulting in similar final functional scores when compared with primary reconstructions. Conclusion: Challenging cases of ACL tears with large chondral defects treated with concurrent ACL reconstruction and ACI can lead to moderately improved pain and function at long-term follow-up. Factors associated with clinical failure are not clear. When combined with ACI, patients undergoing revision ACL reconstructions have worse function preoperatively compared with those undergoing primary reconstructions but have similar final outcomes.

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Repair of Large Chondral Defects of the Knee with Autologous Chondrocyte Implantation in Patients 45 Years or Older

The American Journal of Sports Medicine ◽

10.1177/0363546508322888 ◽

2008 ◽

Vol 36 (12) ◽

pp. 2336-2344 ◽

Cited By ~ 100

Author(s):

Ralf E. Rosenberger ◽

Andreas H. Gomoll ◽

Tim Bryant ◽

Tom Minas

Keyword(s):

Autologous Chondrocyte Implantation ◽

Rating Scales ◽

Rating Scale ◽

Short Form ◽

Case Series ◽

Younger Patients ◽

Chondral Defects ◽

Chondrocyte Implantation ◽

Autologous Chondrocyte

Background Autologous chondrocyte implantation (ACI) has become an accepted option for the treatment of chondral defects in carefully selected patients. Current recommendations limit this procedure to younger patients, as insufficient data are available to conclusively evaluate outcomes in patients older than 45 years. Hypothesis Cartilage repair with ACI in patients older than 45 years results in substantially different outcomes than those previously reported for younger age groups. Study Design Case series; Level of evidence, 4. Methods This prospective cohort study reviewed patients 45 years of age at the time of treatment with ACI. The clinical evaluation included a patient satisfaction questionnaire and four validated rating scales: Short Form-36, Modified Cincinnati Rating Scale, WOMAC (Western Ontario and McMaster Universities) Osteoarthritis Index, and the Knee Society Score. Results A total of 56 patients 45 years of age were treated with ACI. The average patient age at index surgery was 48.6 years (range, 45–60 years). The minimum follow-up was 2 years (range, 2–11 years; mean, 4.7 years). The cohort included 36 men and 20 women. The mean transplant size was 4.7 cm2 per defect (range, 1–15.0 cm2) and 9.8 cm2 per knee (range, 2.5–31.6 cm2). Twenty-eight patients (50%) underwent concomitant osteotomies to address malalignment. There were 8 failures (14%); 6 of 15 (40%) in patients receiving workers’ compensation (WC) and 2 of 41 (4.9%) in non-WC patients. Additional arthroscopic surgical procedures were required in 24 patients (43%) for periosteal-related problems and adhesions; 88% of these patients experienced lasting improvement. At their latest available follow-up, 72% of patients rated themselves as good or excellent, 78% felt improved, and 81 % would again choose ACI as a treatment option. Conclusion Our results showed a failure rate of ACI in older patients that is comparable with rates reported in younger patient groups. The procedure is associated with a substantial rate of reoperations, mostly for the arthroscopic treatment of graft hypertrophy, similar to that in younger patients.

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