title: Revision cartilage cell transplantation for failed autologous chondrocyte transplantation in chronic osteochondral defects of the knee.
abstract: The management of failed autologous chondrocyte implantation (ACI) and matrix-assisted autologous chondrocyte implantation (MACI) for the treatment of symptomatic osteochondral defects in the knee represents a major challenge. Patients are young, active and usually unsuitable for prosthetic replacement. This study reports the results in patients who underwent revision cartilage transplantation of their original ACI/MACI graft for clinical or graft-related failure. We assessed 22 patients (12 men and 10 women) with a mean age of 37.4 years (18 to 48) at a mean of 5.4 years (1.3 to 10.9). The mean period between primary and revision grafting was 46.1 months (7 to 89). The mean defect size was 446.6 mm(2) (150 to 875) and they were located on 11 medial and two lateral femoral condyles, eight patellae and one trochlea. The mean modified Cincinnati knee score improved from 40.5 (16 to 77) pre-operatively to 64.9 (8 to 94) at their most recent review (p < 0.001). The visual analogue pain score improved from 6.1 (3 to 9) to 4.7 (0 to 10) (p = 0.042). A total of 14 patients (63%) reported an 'excellent' (n = 6) or 'good' (n = 8) clinical outcome, 5 'fair' and one 'poor' outcome. Two patients underwent patellofemoral joint replacement. This study demonstrates that revision cartilage transplantation after primary ACI and MACI can yield acceptable functional results and continue to preserve the joint.
authors.affiliation: Royal National Orthopaedic Hospital, Joint Reconstruction and Cartilage Transplantation Unit, Brockley Hill, Stanmore HA7 4LP, UK.
authors.forename: S
authors.initials: S
authors.lastname: Vijayan
authors.forename: G
authors.initials: G
authors.lastname: Bentley
authors.forename: J
authors.initials: J
authors.lastname: Rahman
authors.forename: T W R
authors.initials: TW
authors.lastname: Briggs
authors.forename: J A
authors.initials: JA
authors.lastname: Skinner
authors.forename: R W J
authors.initials: RW
authors.lastname: Carrington
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery*; D019902:Chondrocytes / Q000637:transplantation*; D046789:Chondromalacia Patellae / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010008:Osteochondritis Dissecans / Q000601:surgery*; D010147:Pain Measurement / Q000379:methods; D012086:Reoperation / Q000379:methods; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACI; Cartilage transplantation; Knee; MACI; Osteochondral defects; Revision