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Treatment Outcomes of Autologous Chondrocyte Implantation for Full-Thickness Articular Cartilage Defects of the Trochlea

Bert Mandelbaum, MD^,*, Jon E. Browne, MD, Freddie Fu, MD, Lyle J. Micheli, MD^||, J. Bruce Moseley, Jr, MD^¶, Christoph Erggelet, MD, PhD^# and Allen F. Anderson, MD^**

From the Santa Monica Orthopaedic and Sports Medicine Research Foundation, Santa Monica, California, Orthopaedic Sports Medicine Fellowship Program, University of Missouri–Kansas City, Kansas City, Missouri, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, ^|| Division of Sports Medicine, Department of Orthopaedic Surgery, Children’s Hospital, Harvard Medical School, Boston, Massachusetts, ^¶ Methodist Center for Sports Medicine, The Methodist Hospital, Houston, Texas, ^# Department of Orthopaedic Surgery, Albert-Ludwigs University, Freiburg, Germany, and the ^** Tennessee Sports Alliance/The Lipscomb Clinic, Nashville, Tennessee

^* Address correspondence to Bert R. Mandelbaum, MD, Santa Monica Orthopaedic and Sports Medicine Research Foundation, 1301 20th Street, Suite 150, Santa Monica, CA 90404 (e-mail: bmandelbau{at}aol.com).

Background: The treatment of trochlear cartilage lesions is challenging given the likely presence of other patellofemoral joint pathologies, the topography of the area, and the limited available treatment options. Only 1 other study has examined the effectiveness of autologous chondrocyte implantation for lesions of the patellofemoral joint.

Hypothesis: Patients treated with autologous chondrocyte implantation for moderate to large isolated lesions located on the trochlea will report improvement in the modified overall condition scale score of the Cincinnati Knee Rating System at a minimum 2-year follow-up.

Study Design: Case series; Level of evidence, 4.

Methods: Using modified scales of the Cincinnati Knee Rating System, 40 Cartilage Repair Registry patients rated their overall condition and symptoms at baseline and at a mean follow-up of 59 ± 18 months. Factors likely to affect outcomes also were analyzed.

Results: At baseline, patients were between ages 16 to 48 years, had a mean total defect size of 4.5 cm², and reported an overall condition score of 3.1 points (poor). Many failed a prior marrow-stimulation procedure (48%). Other procedures performed before baseline included tibiofemoral osteotomy in 23% and lateral release or Fulkerson for patella maltracking in 13%. Forty-three percent were receiving workers’ compensation at baseline. Patients reported statistically significant improvement in their mean overall condition (3.1 points preoperatively to 6.4 points postoperatively), pain (2.6 to 6.2 points), and swelling (3.9 to 6.3 points) scores. Eleven patients experienced 17 subsequent procedures, and no patients had a failed implantation.

Conclusion: Autologous chondrocyte implantation appears to improve function and reduce symptoms in young to middle-aged patients with symptomatic, full-thickness articular cartilage lesions of the trochlea.

Key Words: autologous chondrocyte implantation (ACI) • trochlea • chondral defects • cartilage repair • outcomes • patellofemoral

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				B. J. Cole A Randomized Trial Comparing Autologous Chondrocyte Implantation with Microfracture J. Bone Joint Surg. Am., May 1, 2008; 90(5): 1165 - 1165. [Full Text] [PDF]