18.2.9 - Patellofemoral Cartilage Lesions Treated with a Hyaluronan-Based MACT Technique: Results at >15 Years’ Follow-up
- L. Andriolo (Bologna, IT)
- L. Andriolo (Bologna, IT)
- L. Angelelli (Bologna, IT)
- A. Boffa (Bologna, IT)
- M. Franceschini (Bologna, IT)
- D. Reale (Bologna, IT)
- A. Di Martino (Bologna, IT)
- S. Zaffagnini (Bologna, IT)
- G. Filardo (Bologna, IT)
Abstract
Purpose
Cartilage lesions of the patellofemoral joint are a challenging condition for orthopedic surgeons. Hyaluronan-based matrix assisted autologous chondrocyte transplantation (MACT) seems to offer significant improvement in the short and mid-term follow-up. The aim of this prospective study was to analyze the long-term results of MACT technique to address patellofemoral cartilage lesions.
Methods and Materials
A total of 38 patients (23 men, 15 women) with full-thickness patellofemoral chondral lesions were treated with a hyaluronan-based MACT and followed prospectively for a minimum follow-up of 15 years (mean 17.8±1.7 years). Twenty-four lesions were located on patella, 10 on trochlea, and 4 patients had both patellar and trochlear defects. Results were evaluated using International Knee Documentation Committee (IKDC) subjective, EuroQol visual analogue scale (EQ-VAS) and Tegner scores.
Results
A statistically significant improvement in all scores was observed up to the final follow-up compared to the preoperative level. The IKDC subjective score improved from 35.3±12.8 at baseline to 75.5±18.9 at 5 years (P<0.0005), then remained stable at 10 years (77.7±19.8), while decreased (not significant) at the final follow-up (68.6±22.6). The mean of EQ-VAS score increased from 54.2±18.1 to 82,6±12.1 (P<0.0009) at 5 years and then remained stable up to 15 years (82.9±14) (P<0.0005). Finally, the sport activity level evaluated with the Tegner score improved significantly from the preoperative score of 1.8±1.1 to the final evaluation score of 3.5±1.7, even if it remained lower with respect to activity level before onset of symptoms (6.4±1.8). Trochlear lesions showed better results compared with patellar lesions (IKDC at 15 years: 80.2±22.9 vs 61.8±21.7, respectively). Three failures were reported: 2 patients required a total knee arthroplasty, and one patient received a scaffold-procedure).
Conclusion
Hyaluronan-based MACT showed positive clinical results and a low failure rate in patients with patellofemoral cartilage lesions up to long-term follow-up. Better results were observed in patients with isolated throclear lesions.