Purpose
To compare clinical outcomes of patients undergoing isolated patellofemoral autologous
chondrocyte implantation (ACI) and ACI combined with patellofemoral realignment.
Methods
A systematic review was performed by use of PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) guidelines/checklist. We searched PubMed, CINAHL
(Cumulative Index to Nursing and Allied Health Literature), SportDiscus, and the Cochrane
Central Register of Controlled Trials databases from 1946 through February 2012 to
determine whether a difference exists in outcomes of combined ACI and osteotomy versus
isolated ACI (minimum 2 years' follow-up). Studies were included only if outcomes
were reported separately for both isolated ACI and combined ACI and osteotomy. All
ACI generations were eligible for inclusion. Patellofemoral osteotomies eligible for
inclusion were anteriorization, medialization, or anteromedialization. All patient-,
limb-, and defect-specific characteristics were assessed. All reported clinical scores,
radiographic and histologic outcomes, and complications/reoperations were analyzed.
Risk of bias was assessed within all studies.
Results
Eleven studies (10 Level III or IV evidence) (366 subjects) were included. Of the
defects treated, 78% were located on the patella and 22% on the trochlea. The mean
subject age was 33.3 years. Twenty-three percent of subjects underwent concomitant
osteotomy. The mean length of follow-up was 4.2 years. Significant (P < .05) improvements in patients undergoing both isolated ACI and combined ACI and
osteotomy for patellofemoral chondral defects were observed in all studies. Three
studies directly compared isolated ACI and combined ACI and osteotomy, with significantly
(P < .05) greater improvements shown in patients undergoing combined osteotomy and ACI
(International Knee Documentation Committee subjective score, Lysholm score, Knee
Injury and Osteoarthritis Outcome Score, Tegner score, modified Cincinnati score,
Short Form 12 score, and Short Form 36 score). There was no significant difference
between groups in the rate of postoperative complications overall.
Conclusions
This review showed statistically significant improvements in patients undergoing both
isolated ACI and ACI combined with osteotomy for patellofemoral chondral defects in
all studies. When individual studies compared these 2 groups (3 studies), significantly
greater improvements in multiple clinical outcomes in subjects undergoing ACI combined
with osteotomy were observed. There was no significant difference in the rate of total
complications between groups.
Level of Evidence
Level IV, systematic review of studies with minimum Level IV evidence, retrospective
case series.
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References
- Autologous chondrocytes used for articular cartilage repair: An update.Clin Orthop Relat Res. 2001; : S337-S348
- Autologous chondrocyte transplantation of the ankle.Foot Ankle Clin. 2003; 8: 291-303
- Autologous chondrocyte implantation: A long-term follow-up.Am J Sports Med. 2010; 38: 1117-1124
- Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.N Engl J Med. 1994; 331: 889-895
- The role of autologous chondrocyte implantation in the patellofemoral joint.Clin Orthop Relat Res. 2005; : 30-39
- Characteristic complications after autologous chondrocyte implantation for cartilage defects of the knee joint.Am J Sports Med. 2008; 36: 2091-2099
- Shear and compression differentially regulate clusters of functionally related temporal transcription patterns in cartilage tissue.J Biol Chem. 2006; 281: 24095-24103
- Cartilage tissue remodeling in response to mechanical forces.Annu Rev Biomed Eng. 2000; 2: 691-713
- Effect of compressive strain on cell viability in statically loaded articular cartilage.Biomech Model Mechanobiol. 2006; 5: 123-132
- Autologous chondrocyte implantation improves patellofemoral cartilage treatment outcomes.Clin Orthop Relat Res. 2007; 463: 187-194
- Distal realignment and patellar autologous chondrocyte implantation: Mid-term results in a selected population.Knee Surg Sports Traumatol Arthrosc. 2009; 17: 2-10
- Diagnosis and treatment of recurrent dislocations of the patella.Rev Chir Orthop Reparatrice Appar Mot. 1964; 50 (in French): 813-824
- Advancement of the tibial tuberosity.Clin Orthop Relat Res. 1976; : 225-230
- Anteromedial tibial tubercle transfer without bone graft.Am J Sports Med. 1990; 18 (discussion 496-497): 490-496
- Patellofemoral full-thickness chondral defects treated with Hyalograft-C: A clinical, arthroscopic, and histologic review.Am J Sports Med. 2006; 34: 1763-1773
- Periosteal autologous chondrocyte implantation for patellar chondral defect in patients with normal and abnormal patellar tracking.Knee. 2006; 13: 274-279
- Level of evidence in orthopaedic journals.J Bone Joint Surg Am. 2005; 87: 2632-2638
- The use of autologous chondrocyte implantation following and combined with anterior cruciate ligament reconstruction.Int Orthop. 2006; 30: 48-53
- Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: Results at 5 years' follow-up.Am J Sports Med. 2009; 37: 1083-1092
- Importance of sports in cartilage regeneration after autologous chondrocyte implantation: A prospective study with a 3-year follow-up.Am J Sports Med. 2007; 35: 1261-1268
- The role of autologous chondrocyte implantation in the treatment of symptomatic chondromalacia patellae.Int Orthop. 2012; 36: 1371-1377
- Autologous chondrocyte implantation for the treatment of retropatellar cartilage defects: Clinical results referred to defect localisation.Arch Orthop Trauma Surg. 2008; 128: 1223-1231
- Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: Prospective evaluation at average 4-year follow-up.Am J Sports Med. 2009; 37: 33S-41S
- Atelocollagen-associated autologous chondrocyte implantation for the repair of chondral defects of the knee: A prospective multicenter clinical trial in Japan.J Orthop Sci. 2009; 14: 579-588
- Malalignment and cartilage lesions in the patellofemoral joint treated with autologous chondrocyte implantation.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 452-457
- Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer.Am J Sports Med. 1997; 25: 533-537
- Autologous chondrocyte transplantation. Biomechanics and long-term durability.Am J Sports Med. 2002; 30: 2-12
- Autologous chondrocyte implantation and anteromedialization in the treatment of patellofemoral chondrosis.Orthop Clin North Am. 2008; 39 (vi): 329-335
- Surgical biomechanics of the patellofemoral joint.Arthroscopy. 2007; 23: 542-553
- Trochlear contact pressures after anteromedialization of the tibial tubercle.Am J Sports Med. 2005; 33: 1710-1715
- Autologous chondrocyte implantation: A systematic review.J Bone Joint Surg Am. 2010; 92: 2220-2233
- Failures, re-operations, and complications after autologous chondrocyte implantation—A systematic review.Osteoarthritis Cartilage. 2011; 19: 779-791
Article info
Publication history
Published online: January 10, 2013
Accepted:
October 6,
2012
Received:
August 29,
2012
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
