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Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: prospective evaluation at average 4-year follow-up.

Abstract

BACKGROUND

Reported results of autologous chondrocyte implantation for chondral lesions in the patellofemoral joint have been encouraging when combined with realignment procedures.

PURPOSE

The objective of this study was to examine the clinical results of a patient cohort undergoing autologous chondrocyte implantation of the patellofemoral joint and elucidate characteristics associated with successful implantation.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

The cohort included 62 patients who underwent autologous chondrocyte implantation of the PF joint. The mean defect size was 4.2 cm(2) (+/-1.6). The average age was 31.8 years (range, 15.8-49.4), and the average follow-up was 4 years (range, 2-7). Outcomes were assessed via clinical assessment and established outcome scales, including the Lysholm, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Scale (KOOS; includes the 5 categories of Pain, Symptoms, Activities of Daily Living, Sport, and Quality of Life), Tegner, Cincinnati, and Short Form-12.

RESULTS

Mean improvement in the preoperative to postoperative scores was significant for the Lysholm (37-63, P <.001), International Knee Documentation Committee (31-57, P <.001), KOOS Pain (48-71, P <.001), KOOS Symptoms (51-70, P <.001), KOOS Activities of Daily Living (60-80, P <.001), KOOS Sport (25-42, P <.001), KOOS Quality of Life (24-49, P <.001), Short Form-12 Physical (38-41, P <.05), Cincinnati (43-63, P <.005), and Tegner (4-6, P <.05), but not for the Short Form-12 Mental. There was no statistical difference between outcomes in patients with a history of a previous failed cartilage procedure compared with those patients without a prior cartilage procedure (P > .05). Patients undergoing anteromedialization tended toward better outcomes than those without realignment. Forty-four percent of patients needed a subsequent procedure. There were 4 clinical failures (7.7%), which were defined as progression to arthroplasty or conversion to osteochondral allograft transplantation.

CONCLUSION

Autologous chondrocyte implantation is a viable treatment option for chondral defects of the patellofemoral joint. Combined autologous chondrocyte implantation with anteromedialization improves outcomes more than autologous chondrocyte implantation alone. Patients with failed prior cartilage procedures can also expect sustained and clinically meaningful improvement.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Orthopedic Surgery and Anatomy & Cell Biology, Section Head, Rush Cartilage Restoration Center, Rush University Medical Center, 1725 West Harrison Street, Chicago, IL 60612, USA.

    , , ,

    Source

    The American journal of sports medicine 37 Suppl 1: 2009 Nov pg 33S-41S

    MeSH

    Adolescent
    Adult
    Cartilage, Articular
    Chondrocytes
    Female
    Humans
    Male
    Middle Aged
    Outcome Assessment (Health Care)
    Patellofemoral Joint
    Patient Satisfaction
    Postoperative Care
    Prospective Studies
    Surgical Procedures, Operative
    Transplantation, Autologous
    Young Adult

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    19861699

    Citation

    Pascual-Garrido, Cecilia, et al. "Recommendations and Treatment Outcomes for Patellofemoral Articular Cartilage Defects With Autologous Chondrocyte Implantation: Prospective Evaluation at Average 4-year Follow-up." The American Journal of Sports Medicine, vol. 37 Suppl 1, 2009, 33S-41S.
    Pascual-Garrido C, Slabaugh MA, L'Heureux DR, et al. Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: prospective evaluation at average 4-year follow-up. Am J Sports Med. 2009;37 Suppl 1:33S-41S.
    Pascual-Garrido, C., Slabaugh, M. A., L'Heureux, D. R., Friel, N. A., & Cole, B. J. (2009). Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: prospective evaluation at average 4-year follow-up. The American Journal of Sports Medicine, 37 Suppl 1, 33S-41S. doi:10.1177/0363546509349605.
    Pascual-Garrido C, et al. Recommendations and Treatment Outcomes for Patellofemoral Articular Cartilage Defects With Autologous Chondrocyte Implantation: Prospective Evaluation at Average 4-year Follow-up. Am J Sports Med. 2009;37 Suppl 1:33S-41S. PubMed PMID: 19861699.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: prospective evaluation at average 4-year follow-up. AU - Pascual-Garrido,Cecilia, AU - Slabaugh,Mark A, AU - L'Heureux,Daniel R, AU - Friel,Nicole A, AU - Cole,Brian J, Y1 - 2009/10/27/ PY - 2009/10/29/entrez PY - 2009/10/29/pubmed PY - 2010/3/24/medline SP - 33S EP - 41S JF - The American journal of sports medicine JO - Am J Sports Med VL - 37 Suppl 1 N2 - BACKGROUND: Reported results of autologous chondrocyte implantation for chondral lesions in the patellofemoral joint have been encouraging when combined with realignment procedures. PURPOSE: The objective of this study was to examine the clinical results of a patient cohort undergoing autologous chondrocyte implantation of the patellofemoral joint and elucidate characteristics associated with successful implantation. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The cohort included 62 patients who underwent autologous chondrocyte implantation of the PF joint. The mean defect size was 4.2 cm(2) (+/-1.6). The average age was 31.8 years (range, 15.8-49.4), and the average follow-up was 4 years (range, 2-7). Outcomes were assessed via clinical assessment and established outcome scales, including the Lysholm, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Scale (KOOS; includes the 5 categories of Pain, Symptoms, Activities of Daily Living, Sport, and Quality of Life), Tegner, Cincinnati, and Short Form-12. RESULTS: Mean improvement in the preoperative to postoperative scores was significant for the Lysholm (37-63, P <.001), International Knee Documentation Committee (31-57, P <.001), KOOS Pain (48-71, P <.001), KOOS Symptoms (51-70, P <.001), KOOS Activities of Daily Living (60-80, P <.001), KOOS Sport (25-42, P <.001), KOOS Quality of Life (24-49, P <.001), Short Form-12 Physical (38-41, P <.05), Cincinnati (43-63, P <.005), and Tegner (4-6, P <.05), but not for the Short Form-12 Mental. There was no statistical difference between outcomes in patients with a history of a previous failed cartilage procedure compared with those patients without a prior cartilage procedure (P > .05). Patients undergoing anteromedialization tended toward better outcomes than those without realignment. Forty-four percent of patients needed a subsequent procedure. There were 4 clinical failures (7.7%), which were defined as progression to arthroplasty or conversion to osteochondral allograft transplantation. CONCLUSION: Autologous chondrocyte implantation is a viable treatment option for chondral defects of the patellofemoral joint. Combined autologous chondrocyte implantation with anteromedialization improves outcomes more than autologous chondrocyte implantation alone. Patients with failed prior cartilage procedures can also expect sustained and clinically meaningful improvement. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/19861699/Recommendations_and_treatment_outcomes_for_patellofemoral_articular_cartilage_defects_with_autologous_chondrocyte_implantation:_prospective_evaluation_at_average_4_year_follow_up_ L2 - http://journals.sagepub.com/doi/full/10.1177/0363546509349605?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -