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Autologous Chondrocyte Implantation and Tibial Tubercle Osteotomy for Patellofemoral Chondral Defects: Improved Pain Relief and Occupational Outcomes Among US Army Servicemembers.
Am J Sports Med 2018; 46(13):3198-3208AJ

Abstract

BACKGROUND

The occupational and functional results of patellofemoral autologous chondrocyte implantation (ACI) are underreported. This investigation sought to establish clinical outcomes and rates for return to work in a predominantly high-demand military cohort undergoing this procedure.

PURPOSE

To determine the return-to-work, pain relief, and perioperative complication rates in a high-demand athletic cohort undergoing patellofemoral ACI.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

All military servicemembers from 2 military medical centers undergoing ACI for high-grade patellofemoral chondral defects between 2006 and 2014 were identified, and data were abstracted from their medical records and clinical databases. Demographic and surgical variables were obtained for patients with at least 2 years of postoperative follow-up, and perioperative complications, rates of return to work, and survivorship from revision were quantified.

RESULTS

Seventy-two patients (72%) had >2-year follow-up and had patellofemoral ACI for high-grade chondral defects, with 66 knees (91%) undergoing a concomitant offloading tibial tubercle osteotomy. Mean follow-up was 4.3 years (range, 2.0-9.9 years). The mean ± SD age was 34.4 ± 6.1 years; 86% were male; and 57% were involved in military occupational specialties of heavy or very heavy demand. Second-generation patellofemoral ACI with a type I/III collagen membrane was used for 85% of knees. Most defects were isolated to the patella (n = 40, 55%). The mean total defect surface area was 4.5 ± 2.9 cm2 (range, 2.7-13.5 cm2). Fifty-six servicemembers (78%) returned to their occupational specialties. Three patients (4.1%) were classified as having surgical failures, requiring subsequent knee arthroplasty (n = 2) or a revision chondral procedure (n = 1). Mean visual analog scores improved significantly from 6.5 ± 1.5 to 3.2 ± 2.1 (P < .0001). Multivariate analysis identified use of a periosteal patch as the only significant independent predictor for surgical (P = .013) and overall (P = .033) failures. Age <30 years (P = .019), female sex (P = .019), and regular tobacco use (P = .011) were independent predictors of overall failure.

CONCLUSION

For patellofemoral chondral defects without a failed primary procedure, second-generation ACI successfully returned to work 78% of patients of moderate to very heavy occupational demand with significantly decreased patient-reported knee pain. Risk factors after ACI for patellofemoral articular lesions for overall failure were age <30 years, female sex, and tobacco use, while surgical and overall failures were associated with periosteal patch use.

Authors+Show Affiliations

Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA.Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA.Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA.Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA.Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA.Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA.Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA.Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30307742

Citation

Zarkadis, Nicholas J., et al. "Autologous Chondrocyte Implantation and Tibial Tubercle Osteotomy for Patellofemoral Chondral Defects: Improved Pain Relief and Occupational Outcomes Among US Army Servicemembers." The American Journal of Sports Medicine, vol. 46, no. 13, 2018, pp. 3198-3208.
Zarkadis NJ, Belmont PJ, Zachilli MA, et al. Autologous Chondrocyte Implantation and Tibial Tubercle Osteotomy for Patellofemoral Chondral Defects: Improved Pain Relief and Occupational Outcomes Among US Army Servicemembers. Am J Sports Med. 2018;46(13):3198-3208.
Zarkadis, N. J., Belmont, P. J., Zachilli, M. A., Holland, C. A., Kinsler, A. R., Todd, M. S., ... Waterman, B. R. (2018). Autologous Chondrocyte Implantation and Tibial Tubercle Osteotomy for Patellofemoral Chondral Defects: Improved Pain Relief and Occupational Outcomes Among US Army Servicemembers. The American Journal of Sports Medicine, 46(13), pp. 3198-3208. doi:10.1177/0363546518800713.
Zarkadis NJ, et al. Autologous Chondrocyte Implantation and Tibial Tubercle Osteotomy for Patellofemoral Chondral Defects: Improved Pain Relief and Occupational Outcomes Among US Army Servicemembers. Am J Sports Med. 2018;46(13):3198-3208. PubMed PMID: 30307742.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Autologous Chondrocyte Implantation and Tibial Tubercle Osteotomy for Patellofemoral Chondral Defects: Improved Pain Relief and Occupational Outcomes Among US Army Servicemembers. AU - Zarkadis,Nicholas J, AU - Belmont,Philip J,Jr AU - Zachilli,Michael A, AU - Holland,Courtney A, AU - Kinsler,Allison R, AU - Todd,Michael S, AU - Pallis,Mark P, AU - Waterman,Brian R, Y1 - 2018/10/11/ PY - 2018/10/12/pubmed PY - 2019/10/11/medline PY - 2018/10/12/entrez KW - articular cartilage KW - autologous chondrocyte implantation KW - knee KW - military KW - patellofemoral SP - 3198 EP - 3208 JF - The American journal of sports medicine JO - Am J Sports Med VL - 46 IS - 13 N2 - BACKGROUND: The occupational and functional results of patellofemoral autologous chondrocyte implantation (ACI) are underreported. This investigation sought to establish clinical outcomes and rates for return to work in a predominantly high-demand military cohort undergoing this procedure. PURPOSE: To determine the return-to-work, pain relief, and perioperative complication rates in a high-demand athletic cohort undergoing patellofemoral ACI. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All military servicemembers from 2 military medical centers undergoing ACI for high-grade patellofemoral chondral defects between 2006 and 2014 were identified, and data were abstracted from their medical records and clinical databases. Demographic and surgical variables were obtained for patients with at least 2 years of postoperative follow-up, and perioperative complications, rates of return to work, and survivorship from revision were quantified. RESULTS: Seventy-two patients (72%) had >2-year follow-up and had patellofemoral ACI for high-grade chondral defects, with 66 knees (91%) undergoing a concomitant offloading tibial tubercle osteotomy. Mean follow-up was 4.3 years (range, 2.0-9.9 years). The mean ± SD age was 34.4 ± 6.1 years; 86% were male; and 57% were involved in military occupational specialties of heavy or very heavy demand. Second-generation patellofemoral ACI with a type I/III collagen membrane was used for 85% of knees. Most defects were isolated to the patella (n = 40, 55%). The mean total defect surface area was 4.5 ± 2.9 cm2 (range, 2.7-13.5 cm2). Fifty-six servicemembers (78%) returned to their occupational specialties. Three patients (4.1%) were classified as having surgical failures, requiring subsequent knee arthroplasty (n = 2) or a revision chondral procedure (n = 1). Mean visual analog scores improved significantly from 6.5 ± 1.5 to 3.2 ± 2.1 (P < .0001). Multivariate analysis identified use of a periosteal patch as the only significant independent predictor for surgical (P = .013) and overall (P = .033) failures. Age <30 years (P = .019), female sex (P = .019), and regular tobacco use (P = .011) were independent predictors of overall failure. CONCLUSION: For patellofemoral chondral defects without a failed primary procedure, second-generation ACI successfully returned to work 78% of patients of moderate to very heavy occupational demand with significantly decreased patient-reported knee pain. Risk factors after ACI for patellofemoral articular lesions for overall failure were age <30 years, female sex, and tobacco use, while surgical and overall failures were associated with periosteal patch use. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/30307742/Autologous_Chondrocyte_Implantation_and_Tibial_Tubercle_Osteotomy_for_Patellofemoral_Chondral_Defects:_Improved_Pain_Relief_and_Occupational_Outcomes_Among_US_Army_Servicemembers_ L2 - http://journals.sagepub.com/doi/full/10.1177/0363546518800713?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -