Purpose
To evaluate the influence of trochlear dysplasia on clinical outcomes after autologous
chondrocyte implantation (ACI) for the treatment of large cartilage lesions in the
patellofemoral joint (PFJ) with a minimum of 2 years’ follow-up.
Methods
We performed a retrospective review of prospectively collected data of all patients
submitted to cartilage repair with ACI for focal cartilage defects in the PFJ by a
single surgeon. Patient factors, lesion morphology, and preoperative and postoperative
patient-reported outcome measures including the Knee Injury and Osteoarthritis Score,
Lysholm score, Tegner activity level, and International Knee Documentation Committee
Subjective Knee Evaluation Form score were collected. Two independent observers assessed
preoperative imaging to determine the presence and grade of trochlear dysplasia. Patients
were stratified into 2 groups based on the presence or absence of trochlear dysplasia.
Patients without trochlear dysplasia served as controls. Patients were matched 1:1
for sex, age, body mass index, lesion size, and location.
Results
Forty-six patients who underwent ACI in the PFJ with a mean follow-up period of 3.7
± 1.9 years (range, 2-9 years) were enrolled in this study (23 in the trochlear dysplasia
group vs 23 in the normal trochlea group). The patients’ mean age was 30.1 ± 8.8 years.
Patient-reported outcome measures at final follow-up did not differ between the 2
groups (P > .05). No difference in failure rates was seen between the 2 groups (n = 1 [4.3%]
vs n = 1 [4.3%], P > .999). Additionally, no difference in clinical outcomes was seen between patients
with high-grade dysplasia (19 patients; Dejour types B-D) and patients without dysplasia
(19 patients) (P > .05).
Conclusions
ACI in the PFJ provides favorable outcomes even in patients with trochlear dysplasia,
which are comparable to those in patients with normal trochlear anatomy. Thus, trochlear
dysplasia seems to not influence the clinical outcomes of ACI in the PFJ.
Level of Evidence
Level III, retrospective comparative trial.
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Article info
Publication history
Published online: July 14, 2020
Accepted:
July 5,
2020
Received:
January 22,
2020
See commentary on page 3028Footnotes
The authors report the following potential conflicts of interest or sources of funding: A.B.M. receives grant support from Vericel. In addition, A.B.M. receives grant support from JRF Ortho, outside the submitted work. J.A. receives grant support from Vericel. In addition, J.A. receives grant support from JRF Ortho, outside the submitted work. C.E.F. is a consultant for Smith & Nephew and receives fees for medical education from Smith & Nephew, outside the submitted work. A.H.G. receives grant support from Vericel. In addition, A.H.G. receives consulting fees from Vericel/Aastrom/Genzyme/Sanofi, Moximed, JRF, Smith & Nephew, Lifenet, Geistlich, Aesculap, and Nutech/Organogenesis; receives research support from Vericel/Aastrom/Genzyme/Sanofi and JRF; receives travel support from Vericel/Aastrom/Genzyme/Sanofi and Lifenet; receives hospitality fees from Fidia and Stryker; and receives royalties from Nutech/Organogenesis, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2020 by the Arthroscopy Association of North America
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Access this article on ScienceDirectLinked Article
- Editorial Commentary: Trochlear Dysplasia: Can We Change its Natural History or Degenerative Prognosis?ArthroscopyVol. 36Issue 12
- PreviewTrochlear dysplasia may be asymptomatic and benign, or could engender patellar instability and degenerative arthritis. Autologous chondrocyte implantation is demonstrating promising outcomes for the treatment of patellofemoral cartilage lesions, but may not suffice for knees with underlying mechanical anomalies as trochlear dysplasia, where adjuvant trochleoplasty or tibial tubercle osteotomy may be required to prevent patellofemoral instability and to protect the graft from wear and damage. Rigorous radiographic assessment is important to discern the type of dysplasia, notably the presence of a potentially pathogenic supra-trochlear spur.
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