Autologous chondrocyte implantation improves patellofemoral cartilage treatment outcomes.

Abstract

Many patients with patellofemoral pain have multiple knee disorders, such as chondral defects, malalignment, and ligament insufficiency. I reviewed a treatment approach that included autologous chondrocyte implantation and biomechanical altering procedures to reduce impairment and symptoms in patients with patellofemoral lesions and biomechanical disorders. Thirty-eight patients (39 knees; mean age, 31.2 years) had large isolated (trochlear, 4.3 cm2; patellar, 5.4 cm2) or bipolar (mean total surface area, 8.8 cm2) patellofemoral lesions. The minimum followup was 0.5 years (median, 3.1 years; range, 0.5-5.1 years). I observed a median improvement for the following patient and physician scores: modified Cincinnati Knee Rating System scores (3 points each), Lysholm score (31 points), and visual analog scale scores for resting (2 points) and maximum pain (3 points). At a mean followup of 1.2 years in the 22 patients (23 knees) undergoing second-look arthroscopy, autologous chondrocyte implantation repair tissue scored a median of 11 of 12 points using the International Cartilage Repair Society cartilage repair assessment. Twenty-five patients had 32 subsequent surgeries, including 14 to remove hardware from a prior osteotomy. Autologous chondrocyte implantation failed in three patients. Despite the high rate of reoperation, the data suggest combined treatment of autologous chondrocyte implantation and biomechanical altering procedures may be a reasonable option for selected patients with coexisting patellofemoral lesions and mechanical disorders.