Malalignment and cartilage lesions in the patellofemoral joint treated with autologous chondrocyte implantation.
ABSTRACT The aim of our current study is to present the 12.6 years' follow-up results in patients with cartilage lesions of the patellofemoral joint, treated with autologous chondrocyte implantation (ACI) with the use of periosteum.
Ninety-two patients having patella or trochlea lesion participated in this study. Lysholm and Tegner questionnaires were completed 12.6 years (SD 2.3 years) after the surgery. The patients were asked whether they feel better, worse or had not experienced any difference compared to previous years and whether they would undergo the operation again. Complications or subsequent surgeries were also assessed.
Median Tegner score was three, improved by one level compared with preoperative values (P = 0.02). Median Lysholm score was 70, improved by nine points (n.s.). Seventy-two percent of the patients were better or unchanged while 93% would undergo the operation again. Patients with no kissing lesions appeared to have a better prognosis. Patients with malalignment or instability that had undergone a realignment procedure had comparable outcomes to the patients that did not need any additional surgery. Realignment procedures increased the incidence of serious complications but they were associated with decreased incidence of periosteal hypertrophy. No association was found between the age of the patients at the time of the ACI or the size per lesion and any of the clinical outcomes.
ACI provides a satisfactory outcome for the treatment of cartilage lesions of the patellofemoral joint, even for the cases with concomitant patellar instability. It seems that correcting the coexisting background factors with realignment, stabilizing or unloading procedures, along with the treatment of cartilage lesions, is improving the clinical outcomes over time and decreases the incidence of periosteal hypertrophies although increasing the incidence of serious complications. Our study reveals the good results and the high level of patients' activities (as shown by Tegner score), were preserved 12.6 years after the implantation, in both isolated trochlea and patella lesions and also in multiple and in kissing lesions where an intervention could be considered as a salvage procedure.
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ABSTRACT: Osteoarthritis (OA) is a degenerative joint disease affecting approximately 27 million Americans, and even more worldwide. OA is characterized by degeneration of subchondral bone and articular cartilage. In this study, a chondrogenic fibrin/hyaluronic acid (HA)-based hydrogel seeded with bone marrow-derived mesenchymal stem cells (BMSCs) was investigated as a method of regenerating these tissues for OA therapy. This chondrogenic hydrogel system can be delivered in a minimally invasive manner through a small gauge needle, forming a three-dimensional (3D) network structure in situ. However, an ongoing problem with fibrin/HA-based biomaterials is poor mechanical strength. This was addressed by modifying HA with methacrylic anhydride (MA) (HA-MA), which reinforces the fibrin gel, thereby improving mechanical properties. In this study, a range of fibrinogen (the fibrin precursor) and HA-MA concentrations were explored to determine optimal conditions for increased mechanical strength, BMSC proliferation, and chondrogenesis potential in vitro.Journal of Biological Engineering 01/2014; 8:10.
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ABSTRACT: ABSTRACT Background: The patella is the largest human sesamoid bone and often sustains chondral injury. There is no consensus on how to treat a full-thickness, symptomatic articular cartilage injury of the patella. We analyzed the clinical and functional outcomes of patients with symptomatic full-thickness patellar chondral lesions treated with autologous osteochondral transplantation and evaluated osteochondral autograft bone-plug integration through magnetic resonance imaging. Methods: In this prospective study, thirty-three patients with a symptomatic full-thickness patellar chondral injury surgically treated with autologous osteochondral transplantation were evaluated before and after surgical treatment with a minimum two-year follow-up using the Lysholm, Kujala, and Fulkerson questionnaires and the Short Form-36 health survey score. Magnetic resonance images were made at six and twelve months postoperatively and studies were performed to analyze the osteochondral autograft bone-plug integration. Results: All thirty-three patients showed a significant improvement in functional scores two years after surgery. The average Lysholm scores were 57.27 points preoperatively and 80.76 points at two years postoperatively, the average Kujala scores were 54.76 points preoperatively and 75.18 points at two years postoperatively, and the Fulkerson average scores were 54.24 points preoperatively and 80.42 points at two years postoperatively. The Short Form-36 life quality score improved significantly. Two years after surgery, all magnetic resonance images showed full bone-plug integration into the patella. Conclusions: Autologous osteochondral transplantation is a successful technique to surgically treat symptomatic full-thickness patellar articular cartilage injuries smaller than 2.5 cm in diameter. Patients had a significant improvement in clinical scores. Bone-plug integration and surface alignment were demonstrated in all patients two years after surgery. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.The Journal of Bone and Joint Surgery 05/2014; 96(10):816. · 4.31 Impact Factor
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ABSTRACT: Medial patellofemoral ligament (MPFL) reconstruction is a well-established treatment option in recurrent patella dislocation. The combination with associated retropatellar cartilage lesions are severe injuries and very difficult to treat. The purpose of this study was to evaluate our clinical results of MPFL reconstruction and autologous chondrocyte implantation (ACI).Knee Surgery Sports Traumatology Arthroscopy 08/2014; · 2.84 Impact Factor