title: Long-term results of autologous chondrocyte implantation in the knee for chronic chondral and osteochondral defects.
abstract: BACKGROUND
  Autologous chondrocyte implantation (ACI) has been shown to be effective in the midterm for the treatment of symptomatic articular cartilage lesions of the knee, but few long-term series have been published. The multioperated chronic articular cartilage defect remains a difficult condition to treat.
  
  
  OBJECTIVE
  To examine the long-term clinical results of ACI for large chronic articular cartilage defects, many treated as salvage.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  This is a prospective case series of 104 patients with a mean age of 30.2 years and a symptomatic lesion of the articular cartilage in the knee, who underwent ACI between 1998 and 2001. The mean duration of symptoms before surgery was 7.8 years. The mean number of previous surgical procedures on the cartilage defect, excluding arthroscopic debridement, was 1.3. The defects were large, with a mean size of 477.1 mm(2) (range, 120-2500 mm(2)). The modified Cincinnati, Stanmore/Bentley, and visual analog scale for pain scoring systems were used to assess pain and functional outcomes at a minimum 10 years (mean, 10.4 years; range, 10-12 years).
  
  
  RESULTS
  Twenty-seven patients (26%) experienced graft failure at a mean of 5.7 years after ACI. Of the 73 patients who did not fail, 46 patients (63% of patients with a surviving graft) had an excellent result, 18 (25%) were good, 6 (8%) were fair, and 3 (4%) had a poor result. Of a total of 100 patients successfully followed up, 98 were satisfied with the ACI technique for their chronic knee pain and would undergo the procedure again.
  
  
  CONCLUSIONS
  Autologous chondrocyte implantation can provide a long-term solution in more than 70% of young patients of a difficult-to-treat group with large chronic articular cartilage lesions, even in the salvage situation.
authors.affiliation: The Royal Infirmary of Edinburgh, Edinburgh, UK Leela.Biant@luht.scot.nhs.uk.
authors.forename: Leela C
authors.initials: LC
authors.lastname: Biant
authors.affiliation: The Royal National Orthopaedic Hospital, Stanmore, UK.
authors.forename: George
authors.initials: G
authors.lastname: Bentley
authors.affiliation: The Royal National Orthopaedic Hospital, Stanmore, UK.
authors.forename: Sridhar
authors.initials: S
authors.lastname: Vijayan
authors.affiliation: The Royal National Orthopaedic Hospital, Stanmore, UK.
authors.forename: John A
authors.initials: JA
authors.lastname: Skinner
authors.affiliation: The Royal National Orthopaedic Hospital, Stanmore, UK.
authors.forename: Richard W J
authors.initials: RW
authors.lastname: Carrington
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000601:surgery*; D019902:Chondrocytes / Q000637:transplantation*; D003646:Debridement; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: ACI; chronic cartilage lesions; long-term results of ACI; salvage cartilage lesions