Autologous chondrocyte implantation for treatment of focal chondral defects of the knee--a clinical, arthroscopic, MRI and histologic evaluation at 2 years.
To determine the efficacy of autologous chondrocyte implantation (ACI) in treating focal chondral defects of the knee, we reviewed the 2-year treatment outcome of ACI in 53 patients (72 lesions) through clinical evaluation, MRI, second-look arthroscopy and biopsies obtained. Improvement in mean subjective score from preoperative (37.6) to 12 months (56.4) and 24 (60.1) months post-ACI were observed. Knee function levels also improved [86% International Cartilage Repair Society (ICRS) III/IV to 66.6% I/II] from preoperative period to 24 months postimplantation. Objective IKDC score of A or B were observed in 88% preoperatively. This decreased to 67.9% at 3 months before improving to 92.5% at 12 months and 94.4% at 24 months post implantation. Transient deterioration in all these clinical scores was observed at 3 months before progressive improvement became evident. MRI studies demonstrated 75.3% with at least 50% defect fill, 46.3% with near normal signal, 68.1% with mild/no effusion and also 66.7% with mild/no underlying bone marrow oedema at 3 months. These values improved to 94.2%, 86.9%, 91.3% and 88.4%, respectively, at 12 months. At 24 months, further improvements to 97%, 97%, 95.6% and 92.6%, respectively, were observed. Second-look arthroscopy carried out in 22 knees (32 lesions) demonstrated all grafts to be normal/nearly normal based on the International Cartilage Repair Society (ICRS) visual repair assessment while core biopsies from 20 lesions demonstrated 13 grafts to have hyaline/hyaline-like tissue. Improvement in clinical and MRI findings obtained from second-look arthroscopy and core biopsies evaluated indicate that, at 24 months post-ACI, the resurfaced focal chondral defects of the knee remained intact and continued to function well.
Henderson
Ian
I
Orthopaedic Research Department, St. Vincent's and Mercy Private Hospital, 166 Gipps Street, East Melbourne, Victoria 3002, Australia. ijphenderson@hotmail.com
Francisco
Ramces
R
Oakes
Barry
B
Cameron
Julie
J
D000328:Adult; D001182:Arthroscopy; D001707:Biopsy, Needle; D002358:Cartilage, Articular / Q000293:injuries / Q000473:pathology* / Q000502:physiology / Q000601:surgery*; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007718:Knee Injuries / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012038:Regeneration; D024162:Second-Look Surgery; D014182:Transplantation, Autologous; D016896:Treatment Outcome