Articular cartilage defects of the distal femur in children and adolescents: treatment with autologous chondrocyte implantation.
OBJECTIVE
Procedures aimed at biologically repairing cartilage injuries may have the greatest potential benefit in young patients because of their long-life expectancy and high-functional demands. Most cartilage-repair studies focus on older patient populations. This study assesses the outcomes of patients who were treated with autologous chondrocyte implantation before the age of 18.


METHODS
This is a Registry-based, multicenter, observational, cohort study of 37 patients from whom follow-up data was prospectively collected. Patient-rated assessments of overall condition, pain, and swelling were measured using modified, 10-point scales of the Cincinnati Knee Rating System.


RESULTS
Mean age was 16 years (11-17); 22 boys and 15 girls. Twenty-three patients underwent at least 1 cartilage repair procedure before the cartilage harvest, including 11 who had a marrow stimulation procedure. Fourteen patients were diagnosed with osteochondritis dessicans lesions. Thirty-five patients had single defects (mean size, 5.4 cm). Thirty-two patients completed self-evaluations at a minimum of 2 years after implantation (mean follow-up = 4.3 years). The mean change in scale scores measuring overall condition, pain, and swelling were 3.8, 4.1, and 3.4 points, respectively. One patient had an implantation that failed.


CONCLUSIONS
Results highlight significant clinical improvements from baseline to follow-up for 32 patients who submitted follow-up data, including 28 patients who reported a minimum 1-point improvement in the overall condition score.


CONCLUSIONS
These results suggest that autologous chondrocyte implantation may be an effective option for children and adolescents with large symptomatic chondral lesions of the distal femur.
Micheli
Lyle J
LJ
Boston Children's Hospital, MA 02115, USA. michelilyle@aol.com
Moseley
J Bruce
JB
Anderson
Allen F
AF
Browne
Jon E
JE
Erggelet
Christoph
C
Arciero
Robert
R
Fu
Freddie H
FH
Mandelbaum
Bert R
BR
D000293:Adolescent; D002358:Cartilage, Articular / Q000473:pathology; D002648:Child; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D005269:Femur; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D010008:Osteochondritis Dissecans / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome