Intermediate- to Long-Term Results of Combined Anterior Cruciate Ligament Reconstruction and Autologous Chondrocyte Implantation.
BACKGROUND
Cartilage injury associated with anterior cruciate ligament (ACL) ruptures is common; however, relatively few reports exist on concurrent cartilage repair with ACL reconstruction. Autologous chondrocyte implantation (ACI) has been utilized successfully for treatment of moderate to large chondral defects.


OBJECTIVE
ACL insufficiency with relatively large chondral defects may be effectively managed with concurrent ACL reconstruction and ACI.


METHODS
Case series; Level of evidence, 4.


METHODS
Patients undergoing concurrent ACL primary or revision reconstruction with ACI of single or multiple cartilage defects were prospectively evaluated for a minimum 2 years. Pre- and postoperative outcome measures included the modified Cincinnati Rating Scale (MCRS), Western Ontario and McMaster Universities Osteoarthritis Index, visual analog pain scales, and postsurgery satisfaction surveys. ACI graft failure or persistent pain without functional improvement were considered treatment failures.


RESULTS
Twenty-six patients were included, with 13 primary and 13 revision ACL reconstructions performed. Mean defect total surface area was 8.4 cm2, with a mean follow-up of 95 months (range, 24-240 months). MCRS improved from 3.62 ± 1.42 to 5.54 ± 2.32, Western Ontario and McMaster Universities Osteoarthritis Index from 45.31 ± 17.27 to 26.54 ± 17.71, and visual analog pain scale from 6.19 ± 1.27 to 3.65 ± 1.77 (allPs <.001). Eight patients were clinical failures, 69% of patients were improved at final follow-up, and 92% stated they would likely undergo the procedure again. No outcome correlation was found with regard to age, body mass index, sex, defect size/number, follow-up time, or primary versus revision ACL reconstruction. In subanalysis, revision ACL reconstructions had worse preoperative MCRS scores and greater defect surface areas. However, revision MCRS score improvements were greater, resulting in similar final functional scores when compared with primary reconstructions.


CONCLUSIONS
Challenging cases of ACL tears with large chondral defects treated with concurrent ACL reconstruction and ACI can lead to moderately improved pain and function at long-term follow-up. Factors associated with clinical failure are not clear. When combined with ACI, patients undergoing revision ACL reconstructions have worse function preoperatively compared with those undergoing primary reconstructions but have similar final outcomes.
Department of Orthopaedic Surgery, Division of Sports Medicine, Tripler Army Medical Center, Honolulu, Hawaii, USA.
Andrew N
AN
Pike
Department of Orthopaedic Surgery, Cartilage Repair Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts, USA.
Tim
T
Bryant
Department of Orthopaedic Surgery, Cartilage Repair Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts, USA.
Takahiro
T
Ogura
Department of Orthopaedic Surgery, Cartilage Repair Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts, USA.
Tom
T
Minas
anterior cruciate ligament; articular cartilage; autologous chondrocyte implantation; cartilage repair