Original Article| Volume 36, ISSUE 12, P3019-3027, December 2020

Download started.


Trochlear Dysplasia Does Not Affect the Outcomes of Patellofemoral Autologous Chondrocyte Implantation


      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.


      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.


      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).


      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Franciozi C.
        • Vangsness Jr., C.T.
        • Tibone J.E.
        • et al.
        Parylene scaffold for cartilage lesion.
        Biomed Microdevices. 2017; 19: 26
        • Gracitelli G.C.
        • Moraes V.Y.
        • Franciozi C.E.
        • Luzo M.V.
        • Belloti J.C.
        Surgical interventions (microfracture, drilling, mosaicplasty, and allograft transplantation) for treating isolated cartilage defects of the knee in adults.
        Cochrane Database Syst Rev. 2016; 9: CD010675
        • Shkhyan R.
        • Van Handel B.
        • Bogdanov J.
        • et al.
        Drug-induced modulation of gp130 signalling prevents articular cartilage degeneration and promotes repair.
        Ann Rheum Dis. 2018; 77: 760-769
        • Ambra L.F.
        • de Girolamo L.
        • Mosier B.
        • Gomoll A.H.
        Review: Interventions for cartilage disease: Current state-of-the-art and emerging technologies.
        Arthritis Rheumatol. 2017; 69: 1363-1373
        • Mestriner A.B.
        • Ackermann J.
        • Gomoll A.H.
        Patellofemoral cartilage repair.
        Curr Rev Musculoskelet Med. 2018; 11: 188-200
        • Gobbi A.
        • Chaurasia S.
        • Karnatzikos G.
        • Nakamura N.
        Matrix-induced autologous chondrocyte implantation versus multipotent stem cells for the treatment of large patellofemoral chondral lesions: A nonrandomized prospective trial.
        Cartilage. 2015; 6: 82-97
        • Hinckel B.B.
        • Pratte E.L.
        • Baumann C.A.
        • et al.
        Patellofemoral cartilage restoration: A systematic review and meta-analysis of clinical outcomes.
        Am J Sports Med. 2020; 48: 1756-1772
        • Franciozi C.E.
        • Ambra L.F.
        • Albertoni L.J.
        • et al.
        Increased femoral anteversion influence over surgically treated recurrent patellar instability patients.
        Arthroscopy. 2017; 33: 633-640
        • Franciozi C.E.
        • Ambra L.F.
        • Albertoni L.J.B.
        • et al.
        Anteromedial tibial tubercle osteotomy improves results of medial patellofemoral ligament reconstruction for recurrent patellar instability in patients with tibial tuberosity-trochlear groove distance of 17 to 20 mm.
        Arthroscopy. 2019; 35: 566-574
        • Mehl J.
        • Feucht M.J.
        • Bode G.
        • Dovi-Akue D.
        • Sudkamp N.P.
        • Niemeyer P.
        Association between patellar cartilage defects and patellofemoral geometry: A matched-pair MRI comparison of patients with and without isolated patellar cartilage defects.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 838-846
        • Van Haver A.
        • De Roo K.
        • De Beule M.
        • et al.
        The effect of trochlear dysplasia on patellofemoral biomechanics: A cadaveric study with simulated trochlear deformities.
        J Sports Med. 2015; 43: 1354-1361
        • Ntagiopoulos P.G.
        • Byn P.
        • Dejour D.
        Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia.
        J Sports Med. 2013; 41: 998-1004
        • Rouanet T.
        • Gougeon F.
        • Fayard J.M.
        • Remy F.
        • Migaud H.
        • Pasquier G.
        Sulcus deepening trochleoplasty for patellofemoral instability: A series of 34 cases after 15 years postoperative follow-up.
        Orthop Traumatol Surg Res. 2015; 101: 443-447
        • van Sambeeck J.D.P.
        • van de Groes S.A.W.
        • Verdonschot N.
        • Hannink G.
        Trochleoplasty procedures show complication rates similar to other patellar-stabilizing procedures.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2841-2857
        • Trinh T.Q.
        • Harris J.D.
        • Siston R.A.
        • Flanigan D.C.
        Improved outcomes with combined autologous chondrocyte implantation and patellofemoral osteotomy versus isolated autologous chondrocyte implantation.
        Arthroscopy. 2013; 29: 566-574
        • Ebert J.R.
        • Schneider A.
        • Fallon M.
        • Wood D.J.
        • Janes G.C.
        A comparison of 2-year outcomes in patients undergoing tibiofemoral or patellofemoral matrix-induced autologous chondrocyte implantation.
        J Sports Med. 2017; (363546517724761)
        • Vasiliadis H.S.
        • Lindahl A.
        • Georgoulis A.D.
        • Peterson L.
        Malalignment and cartilage lesions in the patellofemoral joint treated with autologous chondrocyte implantation.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 452-457
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Faucett S.C.
        • Dhawan A.
        Research pearls: The significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.
        Arthroscopy. 2017; 33: 1102-1112
        • Gomoll A.H.
        • Ambra L.F.
        • Phan A.
        • Mastrocola M.
        • Shah N.
        Cell-seeded autologous chondrocyte implantation: A simplified implantation technique that maintains high clinical outcomes.
        J Sports Med. 2017; 45: 1028-1036
        • Ackermann J.
        • Barbieri Mestriner A.
        • Arango D.
        • Ogura T.
        • Gomoll A.H.
        Validation of the Oswestry Risk of Knee Arthroplasty Index (ORKA-1) for patients undergoing autologous chondrocyte implantation.
        Cartilage. 2020; 11: 405-411
        • Dejour H.
        • Walch G.
        • Nove-Josserand L.
        • Guier C.
        Factors of patellar instability: An anatomic radiographic study.
        Knee Surg Sports Traumatol Arthrosc. 1994; 2: 19-26
        • Lippacher S.
        • Dejour D.
        • Elsharkawi M.
        • et al.
        Observer agreement on the Dejour trochlear dysplasia classification: A comparison of true lateral radiographs and axial magnetic resonance images.
        J Sports Med. 2012; 40: 837-843
        • Merkely G.
        • Ogura T.
        • Ackermann J.
        • Barbieri Mestriner A.
        • Gomoll A.H.
        Clinical outcomes after revision of autologous chondrocyte implantation to osteochondral allograft transplantation for large chondral defects: A comparative matched-group analysis [published online March 22, 2019]. Cartilage.
        • Frank R.M.
        • Lee S.
        • Cotter E.J.
        • Hannon C.P.
        • Leroux T.
        • Cole B.J.
        Outcomes of osteochondral allograft transplantation with and without concomitant meniscus allograft transplantation: A comparative matched group analysis.
        J Sports Med. 2018; 46: 573-580
        • Cohen J.
        Statistical power analysis for the behavioral sciences. Ed 2.
        Lawrence Erlbaum Associates, Hillsdale, NJ1988
        • Ogura T.
        • Ackermann J.
        • Barbieri Mestriner A.
        • Merkely G.
        • Gomoll A.H.
        Minimal clinically important differences and substantial clinical benefit in patient-reported outcome measures after autologous chondrocyte implantation.
        Cartilage. 2020; 11: 412-422
        • Brittberg M.
        • Lindahl A.
        • Nilsson A.
        • Ohlsson C.
        • Isaksson O.
        • Peterson L.
        Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.
        N Engl J Med. 1994; 331: 889-895
        • Gomoll A.H.
        • Gillogly S.D.
        • Cole B.J.
        • et al.
        Autologous chondrocyte implantation in the patella: A multicenter experience.
        J Sports Med. 2014; 42: 1074-1081
        • von Keudell A.
        • Han R.
        • Bryant T.
        • Minas T.
        Autologous chondrocyte implantation to isolated patella cartilage defects.
        Cartilage. 2017; 8: 146-154
        • Roos E.M.
        • Davis A.
        • Beynnon B.D.
        IKDC or KOOS? Which measures symptoms and disabilities most important to postoperative articular cartilage repair patients?.
        J Sports Med. 2009; 37 (author reply 1043 (letter)): 1042-1043

      Linked Article

      • Editorial Commentary: Trochlear Dysplasia: Can We Change its Natural History or Degenerative Prognosis?
        ArthroscopyVol. 36Issue 12
        • Preview
          Trochlear 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.
        • Full-Text
        • PDF