Patient-Reported and Magnetic Resonance Imaging Outcomes of Third-Generation Autologous Chondrocyte Implantation After 10 Years

• Published in: Arthroscopy Vol. 36; no. 7; pp. 1928 - 1938
• Main Authors: Niethammer, Thomas R., Altmann, Daniel, Holzgruber, Martin, Gülecyüz, Mehmet F., Notohamiprodjo, Susan, Baur-Melnyk, Andrea, Müller, Peter E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2020
• Subjects: Adolescent; Adult; Cartilage Diseases - surgery; Cartilage, Articular - diagnostic imaging; Cartilage, Articular - surgery; Chondrocytes - pathology; Chondrocytes - transplantation; Family Characteristics; Female; Humans; Knee Joint - surgery; Magnetic Resonance Imaging; Male; Middle Aged; Orthopedic Procedures; Pain - surgery; Patient Reported Outcome Measures; Postoperative Period; Transplantation, Autologous; Visual Analog Scale; Young Adult
• ISSN: 0749-8063; 1526-3231
• DOI: 10.1016/j.arthro.2020.03.009

To evaluate the long-term clinical and radiologic outcomes of third-generation autologous chondrocyte implantation (ACI) for the treatment of focal cartilage defects of the knee.
Data capture was carried out between 2004 and 2018. Included were patients with cartilage defects of the knee joint with an International Cartilage Repair Society grade of III or higher treated with third-generation ACI who had a minimum follow-up period of 10 years. International Knee Documentation Committee scores and assessment of pain at rest and on movement using visual analog scale scores were captured preoperatively and at 6 months postoperatively, as well as annually thereafter. In addition, we performed magnetic resonance imaging examinations in 13 cases after 10 years. The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score was used to evaluate the ACI cartilage.
A total of 54 patients met the inclusion criteria. Of these, 30 reached the 10-year follow-up point and were included in this assessment. At 10 years postoperatively, all clinical outcome parameters showed a statistically significant improvement compared with the preoperative situation, with a responder rate of 70%. The average MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score after 10 years was 59.2 points (range, 20-100 points), and over 60% of the evaluated patients showed good integration of the implant at 10 years postoperatively.
The clinical and radiologic findings of this study show that third-generation ACI is a suitable and effective option in the treatment of full-thickness cartilage defects of the knee. At 10 years after surgery, third-generation ACI shows stable results and leads to significant improvement in all clinical outcome parameters. Despite these results, revision surgery after third-generation ACI is common and was needed in 23% of patients in this study.
Level IV, therapeutic case series.