Endoscopic Partial Plantar Fasciotomy via 2 Medial Portals vs Mini-Open Procedure for Refractory Plantar Fasciitis

2020 ◽  
pp. 107110072096480
Author(s):  
Shi-Ming Feng ◽  
Run-Lai Song ◽  
Ai-Guo Wang ◽  
Qing-Qing Sun ◽  
Shu-Cai Zhang
Keyword(s):  
Clinical Outcomes ◽  
Plantar Fasciitis ◽  
Short Form ◽  
Open Group ◽  
Open Procedure ◽  
Sf 36 ◽  
Functional Scores ◽  
Plantar Fasciotomy ◽  
Mini Open ◽  
Endoscopic Group

Background: The treatment of plantar fasciitis may require surgical intervention in patients with ineffective response to conservative treatment. There is a lack of evidence regarding the differences in clinical outcomes between the endoscopic and the mini-open procedures. The purpose of this study was to compare the clinical outcomes of the endoscopic partial plantar fasciotomy via 2 medial portals with mini-open partial plantar fasciotomy for treating refractory plantar fasciitis. Methods: A retrospective analysis was carried out on 62 patients with refractory plantar fasciitis from January 2015 to July 2017. Thirty-three patients received endoscopic partial plantar fasciotomy, while the other 29 received mini-open procedure by patient preference. Two medial portals were used in the endoscopic group while single mini-medial method was used in the open group. All patients were followed up for 24 months. The pain visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, the calcaneodynia score (CS), and the 36-item Short Form Health Survey questionnaire (SF-36) were employed to evaluate the clinical outcomes of the 2 groups. Results: There was increase in the functional scores (eg, VAS, AOFAS, CS, and SF-36) in both groups recorded at 3 months, 6 months, 1 year, and 2 years after surgery. The patients in the endoscopic group had better VAS, AOFAS, CS, and SF-36 scores at 3 months after the surgery compared with those of the open group. During the 6-month follow-up, although the 2 groups showed similar VAS and AOFAS, the CS and SF-36 scores of the endoscopic group were significantly higher than those of the open group. During the 1-year and 2-year follow-ups, the endoscopic group gained equivalent VAS, AOFAS, CS, and SF-36 scores compared with those of the open group. The recurrence rate was similar in both groups. Moreover, the patients in the endoscopic group achieved earlier recovery in comparison to those in the open group. Conclusion: For refractory plantar fasciitis, endoscopic partial plantar fasciotomy via 2 medial portals produced better short-term and equivalent long-term subjective outcomes than the mini-open surgery. Level of Evidence: Level II, comparative study.

Endoscopic Plantar Fasciotomy vs Open Radiofrequency Microtenotomy for Recalcitrant Plantar Fasciitis

2017 ◽  
Vol 39 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Weining Wang ◽  
Inderjeet Singh Rikhraj ◽  
Andrew Chia Chen Chou ◽  
Hwei Chi Chong ◽  
Kevin Oon Thien Koo
Keyword(s):  
Functional Outcomes ◽  
Plantar Fasciitis ◽  
Short Form ◽  
Statistical Significance ◽  
Medical Outcomes ◽  
Level Of Evidence ◽  
Sf 36 ◽  
The Social ◽  
American Orthopaedic ◽  
Plantar Fasciotomy

Background: Although usually self-limiting, around 10% of patients develop recalcitrant plantar fasciitis despite conservative treatment. In such cases, operative intervention can be offered. Traditionally, plantar fasciotomy has been the treatment of choice, but recently, there has been a push for more minimally invasive approaches. Radiofrequency microtenotomy has also been increasingly used as a treatment option. In this study, we compare the outcomes of endoscopic plantar fasciotomy and open radiofrequency microtenotomy. Methods: Patients treated in our institution with either procedure between 2007 and 2015 were included and interviewed at baseline and 3 months, 6 months, and 12 months postoperatively using the American Orthopaedic Foot & Ankle Society (AOFAS) and 36-item Medical Outcomes Short Form (SF-36) questionnaires. They were asked questions to evaluate their expectation and satisfaction postoperatively. Demographic and clinicopathological data were prospectively collected from clinical charts and electronic records. Results: There was no difference in either treatment arms preoperatively and an overall improvement in all functional outcomes postoperatively. However, patients who had endoscopic plantar fasciotomy fared better at 3 months compared to patients who underwent open microtenotomy with the visual analog score component of the AOFAS hindfoot score (HINDVAS) and the social functioning and role-functioning–emotional reaching statistical significance ( P = .027, P = .03, and P = .03, respectively). There was no difference in functional outcomes at 6 or 12 months postoperatively. Conclusion: Endoscopic plantar fasciotomy was associated with an earlier improvement in functional outcome in our study. However, both treatments had equivalent outcomes at 1-year follow-up, suggesting that either method is reasonable in the treatment of chronic plantar fasciitis. Level of Evidence: Level III, comparative study.

Association of Visual Appearance on Outcomes After Hallux Valgus Surgery

2021 ◽  
pp. 107110072110199
Author(s):  
Hakan Bahar ◽  
Kadir Ilker Yildiz
Keyword(s):  
Hallux Valgus ◽  
Short Form ◽  
Functional Improvement ◽  
Level Of Evidence ◽  
Visual Appearance ◽  
Chevron Osteotomy ◽  
Sf 36 ◽  
Functional Scores ◽  
Group 2 ◽  
Group 1

Background: In this study, our aim was to determine the effect of cosmetic improvement on patient satisfaction and functional scores in hallux valgus (HV) surgery. Methods: Preoperative foot photographs of 105 patients who had undergone chevron osteotomy for HV between 2016 and 2018 were taken. The patients were divided into 2 groups. Twenty-four months after surgery, the preoperative foot photographs were shown to patients in group 1 (n = 52) but not to patients in group 2 (n = 53). The groups were then compared using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP), and the 36-Item Short Form Health Survey (SF-36) scores. Both groups were evaluated radiologically with preoperative and postoperative hallux valgus angles and intermetatarsal angles. Results: There was no difference between the 2 groups in terms of radiologic parameters either pre- or postoperatively, or AOFAS Hallux MTP-IP scores postoperatively. However, for group 1, the VAS was lower (0.4±0.8 vs 1.8±1.6, P = .003) and both the SF-36 physical functioning (88.3±18.1 vs 79.1±23.2, P = .017) and SF-36 mental health scores were higher (78.8±19 vs 69.2±16.3, P = .022). Conclusion: Visualizing improvement in the cosmetic appearance of the foot appears associated with patients’ perception of subjective pain and functional improvement. We recommend that preoperative foot photographs be taken and recorded. Level of Evidence: Level III, case-control study.

scholarly journals NONOPERATIVE VERSUS OPERATIVE TREATMENT OF PATIENTS WITH DEGENERATIVE SPONDYLOLISTHESIS

2016 ◽  
Vol 15 (1) ◽  
pp. 33-35
Author(s):  
Jose Alfredo Corredor ◽  
Fernando Flores de Araújo ◽  
Rodrigo Góes de Mendonça ◽  
Noel Oizerovici Foni ◽  
Nelson Astur ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Short Form ◽  
Degenerative Spondylolisthesis ◽  
Functional Results ◽  
Good Health ◽  
Nonoperative Treatment ◽  
Function Score ◽  
Cross Sectional ◽  
Sf 36 ◽  
Functional Scores

ABSTRACT Objective: To evaluate clinical and functional results of patients with lumbar degenerative spondylolisthesis treated with operatively or nonoperatively. Methods: Patients with degenerative spondylolisthesis treated either nonoperatively or operatively from 2004 to 2014 were selected from databases and a cross-sectional evaluation was performed. Outcome measures included back and leg visual analogue scales (VAS), Fischgrund criteria, Short Form-36 (SF-36) function score, and the modified Oswestry Disability Index (ODI). Results: 43 patients were evaluated: 20 with nonoperative treatment and 23 with operative treatment. Baseline characteristics were similar without significant differences between groups. Mean follow-up time was 43 months (range 10 - 72) for the nonoperative group and 36 months (range 6-80) for the operative group. Significant statistical difference in favor of operative group were found in back VAS (mean 4 versus 8, p = 0.000), leg VAS (mean 3 versus 6, p = 0.0015), SF-36 function score (mean 77 versus 35, p = 0.000), and ODI (mean 17 versus 46, p = 0.000). On the basis of the Fischgrund criteria, only 10 % of patients reported excellent or good health post nonoperative treatment versus 83% for those treated operatively (p = 0.000). Conclusion: In this cross-sectional study, we observed that symptomatic patients with degenerative spondylolisthesis who underwent operative treatment have superior clinical and functional scores compared to those that underwent nonoperative treatment.

Mapping recovery in simple and complex tibial plateau fracture fixation

2019 ◽  
Vol 101-B (8) ◽  
pp. 1009-1014 ◽  
Author(s):  
D. N. Ramoutar ◽  
K. Lefaivre ◽  
H. Broekhuyse ◽  
P. Guy ◽  
P. O’Brien
Keyword(s):  
Functional Outcome ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Short Form ◽  
Tibial Plateau Fractures ◽  
Functional Score ◽  
Complex Group ◽  
Sf 36 ◽  
Functional Scores ◽  
Plateau Fracture

Aims The aim of this study was to determine the trajectory of recovery following fixation of tibial plateau fractures up to five-year follow-up, including simple (Schatzker I-IV) versus complex (Schatzker V-VI) fractures. Patients and Methods Patients undergoing open reduction and internal fixation (ORIF) for tibial plateau fractures were enrolled into a prospective database. Functional outcome, using the 36-Item Short Form Health Survey Physical Component Summary (SF-36 PCS), was collected at baseline, six months, one year, and five years. The trajectory of recovery for complex fractures (Schatzker V and VI) was compared with simple fractures (Schatzker I to IV). Minimal clinically important difference (MCID) was calculated between timepoints. In all, 182 patients were enrolled: 136 (74.7%) in simple and 46 (25.3%) in complex. There were 103 female patients and 79 male patients with a mean age of 45.8 years (15 to 86). Results Mean SF-36 PCS improved significantly in both groups from six to 12 months (p < 0.001) and one to five years (simple, p = 0.008; complex, p = 0.007). In both groups, the baseline scores were not reached at five years. The SF-36 PCS was significantly higher in the simple group compared with the complex group at both six months (p = 0.007) and 12 months (p = 0.01), but not at five years (p = 0.17). Between each timepoint, approximately 50% or more of the patients in each group achieved an MCID in their score change, indicating a significant clinical change in condition. The complex group had a much larger drop off in the first six months, with comparable proportions achieving MCID at the subsequent time intervals. Conclusion Tibial plateau fracture recovery was characterized overall by an initial decline in functional outcome from baseline, followed by a steep improvement from six to 12 months, and ongoing recovery up to five years. In simple patterns, patients tended to achieve a higher functional score by six months compared with the complex patterns. However, comparable functional scores between the groups achieved only at the five-year point suggest later recovery in the complex group. Function does not improve to baseline by five years in either group. This information is useful in counselling patients about the course of prospective recovery. Cite this article: Bone Joint J 2019;101-B:1009–1014.

Preliminary Experience With SPECT/CT to Evaluate Periarticular Arthritis Progression and the Relationship With Clinical Outcome Following Ankle Arthrodesis

2020 ◽  
Vol 41 (4) ◽  
pp. 392-397
Author(s):  
Christopher DeSutter ◽  
Vincent Dube ◽  
Andrew Ross ◽  
Gordon Boyd ◽  
Joel Morash ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Outcome ◽  
Short Form ◽  
Ankle Arthrodesis ◽  
Emission Computed Tomography ◽  
Diagnostic Study ◽  
Ankle Fusion ◽  
Sf 36 ◽  
Significant Difference ◽  
Functional Scores

Background: Single photon emission computed tomography combined with computed tomography (SPECT/CT) could potentially aid in diagnosing periarticular arthritis/activity and progression, facilitate effective treatment options, and evaluate the effect surgery has on the clinical outcome of patients with ankle arthritis. The goal of our study was to assess SPECT/CT activity in the ankle and periarticular joints before and after ankle fusion surgery and determine whether it was associated with clinical pain and function scores. Methods: Thirty-four patients recruited into this study underwent either arthroscopic or open ankle fusion. X-ray (XR) and SPECT/CT imaging was obtained as well as completion of patient Ankle Osteoarthritis Scale (AOS) and 36-item Short Form Survey (SF-36) questionnaires preoperatively and at 6 months postoperatively. Ankle, subtalar, and talonavicular joint arthritis grading on XR and CT, along with SPECT/CT activity, was evaluated by 2 nuclear medicine radiologists. Data were assessed for normality and analyzed with the appropriate comparative test. P value was set at <.05. Thirty patients (31 ankles) completed follow-up and were analyzed. Results: SPECT/CT activity showed no significant difference in the ankle joint at 6 months postoperatively while periarticular joint activity significantly increased ( P < .05). Six months postoperatively, patients had significant improvements in their AOS and SF-36 scores ( P < .05). SPECT/CT grading of all joints analyzed, however, was not associated with AOS or SF-36 scores preoperatively or at 6 months postoperatively. Conclusion: In this study, intensity of activity as evaluated by SPECT/CT in periarticular hindfoot joints in patients who had ankle arthrodesis was not associated with clinical/functional scores at 6 months postoperatively. Level of Evidence: Level IV, diagnostic study.

Proximal Medial Gastrocnemius Release Versus Open Plantar Fasciotomy for the Surgical Treatment in Recalcitrant Plantar Fasciitis

2019 ◽  
Vol 41 (3) ◽  
pp. 267-274 ◽  
Author(s):  
Carlo Gamba ◽  
Paula Serrano-Chinchilla ◽  
Jesus Ares-Vidal ◽  
Alberto Solano-Lopez ◽  
Gemma Gonzalez-Lucena ◽  
...  
Keyword(s):  
Surgical Management ◽  
Plantar Fasciitis ◽  
Controlled Trial ◽  
Demographic Data ◽  
Medial Gastrocnemius ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Sf 36 ◽  
Plantar Fasciotomy

Background: Plantar fasciitis is a common cause of foot pain. If conservative treatment fails, there is no consensus as to the best surgical management for recalcitrant plantar fasciitis (RPF). The aim of this study was to compare the results obtained from proximal medial gastrocnemius release (PMGR) with those obtained from open plantar fasciotomy (OPF) in terms of pain, satisfaction, health-related quality of life, and American Orthopaedic Foot & Ankle Society (AOFAS) score. Methods: This is a prospective randomized trial conducted between 2012 and 2016. Patients with RPF for at least 9 months were included. Diagnosis was clinically made. The exclusion criteria were neuropathic heel pain; a history of previous foot fracture, surgery, or deformity; rheumatoid arthritis; or the need for long-term analgesic administration. After ruling out other conditions with magnetic resonance or ultrasound imaging, patients were randomized to be operated on with OPF or PMGR independently of the Silfverskjold test. Follow-up was carried out for up to 1 year. The AOFAS, visual analog scale (VAS) for pain, SF-36, and Likert scale for satisfaction were used to evaluate the results obtained. The analysis was done with 21 patients in the OPF group and 15 in the PMGR group. The demographic data (age, sex, body mass index, duration of symptoms, and positivity to the Silfverskjold test) of the groups were comparable. Results: No differences were found in terms of the AOFAS ( P = .24), VAS ( P = .14), or any item of the SF-36. Satisfaction was very good in 85.8% of the PMGR group and 89.5% of the OPF group ( P = .27). Faster recovery was observed in the PMGR group. Conclusion: OPF and PMGR provided good results for patients with RPF. Neither was superior to the other relative to pain, AOFAS score, satisfaction, or the SF-36. We recommend PMGR as the first option in RPF surgical management in order to avoid potential biomechanical complications related to OPF. Level of Evidence: Level I, therapeutic randomized controlled trial.

scholarly journals Is Delayed Weightbearing After Matrix-Associated Autologous Chondrocyte Implantation in the Knee Associated With Better Outcomes? A Systematic Review of Randomized Controlled Trials

2018 ◽  
Vol 6 (5) ◽  
pp. 232596711877098 ◽  
Author(s):  
Matthew J. Kraeutler ◽  
John W. Belk ◽  
Trevor J. Carver ◽  
Eric C. McCarty
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Autologous Chondrocyte Implantation ◽  
Short Form ◽  
Sf 36 ◽  
Patient Reported ◽  
Rehabilitation Protocols ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: Proper rehabilitation after matrix-associated autologous chondrocyte implantation (MACI) is essential to restore a patient’s normal function without overloading the repair site. Purpose: To evaluate the current literature to assess clinical outcomes of MACI in the knee based on postoperative rehabilitation protocols, namely, the time to return to full weightbearing (WB). Study Design: Systematic review; Level of evidence, 1. Methods: A systematic review was performed to locate studies of level 1 evidence comparing the outcomes of patients who underwent MACI with a 6-week, 8-week, or 10/11-week time period to return to full WB. Patient-reported outcomes assessed included the Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity scale, Short Form Health Survey–36 (SF-36), and visual analog scale (VAS) for pain frequency and severity. Results: Seven studies met the inclusion criteria, including a total of 136 patients (138 lesions) who underwent MACI. Treatment failure had occurred in 0.0% of patients in the 6-week group, 7.5% in the 8-week group, and 8.3% in the 10/11-week group at a mean follow-up of 2.5 years ( P = .46). KOOS, SF-36, and VAS scores in each group improved significantly from preoperatively to follow-up ( P < .001). Conclusion: Patients undergoing MACI in the knee can be expected to experience improvement in clinical outcomes with the rehabilitation protocols outlined in this work. No significant differences were seen in failure rates based on the time to return to full WB.

scholarly journals Surgical versus Conservative Management of Weber B Fibular Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0014
Author(s):  
Abduljabbar Alhammoud ◽  
Osama Aldahamsheh
Keyword(s):  
Clinical Outcomes ◽  
Surgical Management ◽  
Short Form ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Functional Score ◽  
Type B ◽  
Significant Difference ◽  
Functional Scores ◽  
The Mean

Category: Trauma Introduction/Purpose: Fibular fractures are one of the most common traumatic injuries treated by orthopaedic surgeons. These fractures range from stable to unstable, and accordingly may be treated conservatively with immobilization or operatively with open reduction and internal fixation. Unstable Weber classification type B fibula fractures are at the level of the syndesmosis. When stressed, they show an increased medial clear space widening. Recent studies have suggested these fractures may be treated non-operatively. The purpose of this study was to systematically review the literature to determine whether operative and non-operative management of Weber B fractures exhibit any difference in functional outcomes. Methods: For this study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) guidelines were followed. A systematic review of the literature was performed on the Medline (PubMed), Ovid, and Embase databases in May 2017. Only studies analyzing surgical and non-surgical management of Weber B fibular fractures were included. A meta-analysis was performed to pool difference of the mean for functional outcome scores (Olerud Molander Ankle [OMA] score, American Orthopaedic Foot and Ankle Score [AOFAS], Visual Analogue Scale [VAS], and Short-form 36 [SF36] questionnaire) of the ankles of patients who underwent surgical and non-surgical management. Descriptive, quantitative, and qualitative data were extracted and analyzed using Comprehensive meta-analysis software and SPSS 21. Random effect model used to pool the difference of the mean of the outcomes and I2 to assess the heterogeneity. Results: Of the 823 articles identified, four studies met inclusion criteria for the meta-analysis. A total of 383 unstable Weber type B fibular fractures were identified, with 198 treated operatively and 161 treated non-operatively. There were 158 (41.2%) male and 225 (58.8%) female patients, who averaged 45.6 years of age (Table). Mean follow up was 27.3 months. The pooled mean difference (SMD) for OMA functional score did not show any statistically significant difference between surgical and non-surgical management (SMD = 12.364 [95% CI: -4.684, 29.413]; I2 = 91.93%), although each single paper highlighted the superiority of non-surgical management. Other functional scores could not be pooled because they were not consistently reported within the included studies. Conclusion: The early literature suggests that there is no difference in the clinical outcomes of unstable Weber B fractures, whether they are treated operatively or non-operatively. Longer-term studies are warranted to examine the clinical outcomes of patients managed non-operatively.

A Randomized Controlled Trial of Custom Foot Orthoses for the Treatment of Plantar Heel Pain

2015 ◽  
Vol 105 (4) ◽  
pp. 281-294 ◽  
Author(s):  
James S. Wrobel ◽  
Adam E. Fleischer ◽  
Ryan T. Crews ◽  
Beth Jarrett ◽  
Bijan Najafi
Keyword(s):  
Physical Activity ◽  
Outcome Measures ◽  
Plantar Fasciitis ◽  
Short Form ◽  
Controlled Trial ◽  
Heel Pain ◽  
Foot Orthoses ◽  
Double Blind ◽  
Sf 36 ◽  
Spontaneous Physical Activity

Background Up to 10% of people will experience heel pain. The purpose of this prospective, double-blind, randomized clinical trial was to compare custom foot orthoses (CFO), prefabricated foot orthoses (PFO), and sham insole treatment for plantar fasciitis. Methods Seventy-seven patients with plantar fasciitis for less than 1 year were included. Outcome measures included first step and end of day pain, Revised Foot Function Index short form (FFI-R), 36-Item Short Form Health Survey (SF-36), activity monitoring, balance, and gait analysis. Results The CFO group had significantly improved total FFI-R scores (77.4 versus 57.2; P = .03) without group differences for FFI-R pain, SF-36, and morning or evening pain. The PFO and CFO groups reported significantly lower morning and evening pain. For activity, the CFO group demonstrated significantly longer episodes of walking over the sham (P = .019) and PFO (P = .03) groups, with a 125% increase for CFOs, 22% PFOs, and 0.2% sham. Postural transition duration (P = .02) and balance (P = .05) improved for the CFO group. There were no gait differences. The CFO group reported significantly less stretching and ice use at 3 months. Conclusions The CFO group demonstrated 5.6-fold greater improvements in spontaneous physical activity versus the PFO and sham groups. All three groups improved in morning pain after treatment that included standardized athletic shoes, stretching, and ice. The CFO changes may have been moderated by decreased stretching and ice use after 3 months. These findings suggest that more objective measures, such as spontaneous physical activity improvement, may be more sensitive and specific for detecting improved weightbearing function than traditional clinical outcome measures, such as pain and disease-specific quality of life.

A 20-Year Follow-up After First-Generation Autologous Chondrocyte Implantation

2017 ◽  
Vol 45 (12) ◽  
pp. 2751-2761 ◽  
Author(s):  
Takahiro Ogura ◽  
Brian A. Mosier ◽  
Tim Bryant ◽  
Tom Minas
Keyword(s):  
Articular Cartilage ◽  
Clinical Outcomes ◽  
Autologous Chondrocyte Implantation ◽  
First Generation ◽  
Short Form ◽  
Cartilage Defects ◽  
Sf 36 ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: Treating articular cartilage defects is a demanding problem. Although several studies have reported durable and improved clinical outcomes after autologous chondrocyte implantation (ACI) over a long-term period, there is no report with over 20 years’ follow-up. Purpose: To evaluate clinical outcomes after first-generation ACI for the treatment of knees with disabling, large single and multiple cartilage defects for which patients wished to avoid prosthetic arthroplasty, with a minimum of 20 years’ follow-up. Study Design: Case series; Level of evidence, 4. Methods: The authors reviewed prospectively collected data from 23 patients (24 knees; mean age, 35.4 years [range, 13-52 years]) undergoing ACI for the treatment of symptomatic, full-thickness articular cartilage lesions. A mean of 2.1 lesions per knee were treated over a mean total surface area of 11.8 cm2 (range, 2.4-30.5 cm2) per knee. Kaplan-Meier survival analysis and functional outcome scores, including the modified Cincinnati Knee Rating System, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form–36 (SF-36), were used. Patients also self-reported an improvement in pain with a visual analog scale and a satisfaction survey. Results: The 20-year survival rate was 63% (95% CI, 40%-78%). The evaluation of the 15 knees with retained grafts demonstrated that all clinical scores except the WOMAC subscore for stiffness and SF-36 mental component summary score improved significantly and were sustained to 20 years postoperatively. Ninety-three percent of these patients rated knee-specific outcomes as good or excellent. The outcomes for 9 of 24 knees were considered failures, including 5 undergoing revision ACI and 4 being converted to arthroplasty at a mean of 1.7 and 5.9 years, respectively. Only 1 of 5 knees that underwent revision ACI was converted to arthroplasty at 1.9 years after the index surgery, and the other 4 patients were able to maintain their biological knee. Overall, 20 years later, 79% of patients maintained their native knee, for which they initially sought treatment, and were satisfied when evaluated. Conclusion: First-generation ACI provided satisfactory survival rates and significant clinical improvements over a 20-year follow-up, which offers an important standard for comparison with newer-generation ACI technologies of the future.

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