title: First-generation autologous chondrocyte implantation in patients with cartilage defects of the knee: 7 to 14 years' clinical and magnetic resonance imaging follow-up evaluation.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the overall long-term improvement of autologous chondrocyte implantation (ACI) treatment in terms of patient satisfaction, clinical assessment, and magnetic resonance imaging (MRI) evaluation. Furthermore, we aimed to assess the impact of independent variables on clinical outcomes and patient satisfaction.
  
  
  METHODS
  We evaluated 23 patients (mean age, 30.5 ± 8.2 years) with full-thickness chondral lesions of the distal femur who underwent first-generation ACI with periosteum between 1997 and 2004. The Lysholm score, Tegner activity score, subjective International Knee Documentation Committee score, numeric rating scale score, and Short Form 36 score were used for clinical assessment preoperatively, at 1 year postoperatively, and at 7 to 14 years (mean, 9.9 years) after surgery. MRI was performed to evaluate the cartilage preoperatively and at final follow-up, by use of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score.
  
  
  RESULTS
  ACI resulted in a substantial improvement in all clinical outcome parameters, even as much as 14 years after implantation, although a small deterioration was noticed between intermediate and final evaluations in some outcome parameters. Of the patients, 73.1% stated that they would undergo the operation again. Younger patients with a shorter duration of preoperative symptoms and smaller defect sizes benefited most. MRI findings confirmed complete defect filling in 52.3% of the patients at final follow-up.
  
  
  CONCLUSIONS
  Our long-term results confirm that first-generation ACI is an effective treatment for large full-thickness chondral and osteochondral lesions of the knee joint. Younger patients with a shorter duration of preoperative symptoms and smaller defect size benefited most in our study.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Department of Orthopaedics, Trauma Surgery and Paraplegiology, University Clinic of Heidelberg, Heidelberg, Germany. babak.moradi@med.uni-heidelberg.de
authors.forename: Babak
authors.initials: B
authors.lastname: Moradi
authors.forename: Eva
authors.initials: E
authors.lastname: Schönit
authors.forename: Corinna
authors.initials: C
authors.lastname: Nierhoff
authors.forename: Sébastien
authors.initials: S
authors.lastname: Hagmann
authors.forename: Doris
authors.initials: D
authors.lastname: Oberle
authors.forename: Tobias
authors.initials: T
authors.lastname: Gotterbarm
authors.forename: Holger
authors.initials: H
authors.lastname: Schmitt
authors.forename: Felix
authors.initials: F
authors.lastname: Zeifang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery*; D017690:Cell Transplantation; D019902:Chondrocytes / Q000637:transplantation*; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055034:Osteochondrosis / Q000601:surgery*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult