T. Ogura (Boston, US)
Brigham and Women's Hospital Orthopaedic SurgeryPresenter Of 1 Presentation
10.1.6 - Autologous chondrocyte implantation for bipolar chondral lesions in the patellofemoral compartment
Abstract
Purpose
To evaluate the clinical outcomes after autologous chondrocyte implantation (ACI) for the treatment of bipolar chondral lesions in the patello-femoral (PF) compartment.
Methods and Materials
We evaluated 58 patients who had ACI for the treatment of symptomatic bipolar chondral lesions in the PF compartment. All 58 patients (60 knees) were included with a minimum of 2 year follow-up. Forty-two patients had osteotomy as those had patellofemoral lateral maltracking, patellar instability, or tibiofemoral malalignment. Patients were evaluated with the modified Cincinnati Knee Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index, Visual Analogue Scale, the Short Form 36, and a patient satisfaction survey. Radiographs were evaluated with Iwano classification.
Results
Overall, the survival rate was 83% and 79% at 5 and 10 years, respectively. Of the 49 (82%) knees with retained grafts, all functional scores significantly improved postoperatively with a very high satisfaction rate (88%) at a mean of 8.8 years after ACI. At the most recent follow-up, 28 of 49 successful knees were radiographically assessed (average, 4.9 years postoperatively), with no significant osteoarthritis progression (P = 0.1573). Outcomes for 11 patients were considered as failures at a mean of 2.9 years. The best survival rates were observed in patients who underwent ACI with concomitant tibial tubercle osteotomy (TTO) done as a first procedure without previous failed TTO and/or marrow stimulation technique (91% at both 5 and 10 years), while the worst survival rates were observed in patients who had previous marrow stimulation technique (43% at both 5 and 10 years).
Conclusion
Our results demonstrated that ACI with concomitant osteotomy when it is necessary for the treatment of bipolar lesions in the PF compartments gives significant improvement in pain and function with a good survival rate of 83% and 79% at 5 and 10 years, respectively.