March 13th, 2004
AOSSM Specialty Day

Treatment Outcomes of Autologous Chondrocyte Implantation for Multiple Defects of the Distal Femur

Authors:
  1. Allen F. Anderson MD, Tennessee Orthopaedic Alliance/ The Lipscomb Clinic, Nashville, TN
  2. Bert R. Mandelbaum MD, Santa Monica Orthopaedic and Sports Medicine Research Foundation, Santa Monica, CA
  3. Jon E. Browne MD, Orthopaedic and Sports Medicine Clinic of Kansas City, PA, Kansas City, MO
  4. Lyle J. Micheli MD, Children's Hospital, Boston, MA
  5. Freddie H. Fu MD, University of Pittsburgh School of Medicine, Pittsburgh, PA
  6. Christoph Erggelet MD, PhD, University of Freiburg, Freiburg, Germany
  7. J. Bruce Moseley MD, Baylor Sports Medicine Group, Houston, TX
  8. Robert A. Arciero LTC (ret.) MD, University of Connecticut, Farmington, CT
Objective:  Treatment of large multifocal cartilage defects is challenging due to the complex knee pathology and significant baseline impairments that are associated with these defects. The purpose of this paper is to report the multicenter outcomes of patients who were treated with ACI for multifocal defects of the distal femur.
Methods:  113 patients with at least 2 full-thickness chondral lesions of the distal femur were prospectively followed and evaluated preoperatively and at a minimum of 2-years follow-up using the 10-point modified Cincinnati Knee Rating System. The primary endpoint of this study is the mean change in the overall condition score from baseline to follow-up.
Results:   107 patients completed evaluations at a mean follow-up of 4.18 years. Overall, patients were 39 years of age and predominantely male (74%). Sixty-six percent underwent at least one cartilage repair procedure prior to cartilage harvest, including 35% who had a marrow stimulation procedure. Thirty seven percent were receiving worker’s compensation. Eighty-three percent had normal patella tracking and 80% had normal tibial-femoral alignment. Approximately 19% had mild varus and valgus malalignment. Overall, the total defect area was 9.4 cm2. The overall condition score improved 2.1 points for 107 patientswith follow-up, (p<0.0001), and 3.6 points for 71 patientswho improved,(p<0.0001). For all patients, pain and swelling scores improved 2.2(p<0.0001) and 1.4 points (p=0.0004), respectively. Twelve patients failed ACI.
Conclusions:  Patients treated with ACI for multifocal lesions reported statistically and clinically significant functional and symptomatic improvement at a mean follow-up of 4.18 years. These results suggest that ACI is effective for patients with large, symptomatic, full-thickness multifocal lesions.
References:  
  1. Minas T. Autologous Chondrocyte Implantation for Focal Chondral Defects of the Knee. Clinical Orthopaedics and Related Research 2001; 391S:S349-S361.
Keywords:
  1. Cartilage
 Categories:
  1. CLINICAL: Knee - Articular Cartilage