Cell-based Therapy Improves Function in Adolescents and Young Adults With Patellar Osteochondritis Dissecans

Abstract

Background Recent advances have been made in using chondrocytes and other cell-based therapy to treat cartilage defects in adults. However, it is unclear whether these advances should be extended to the adolescent and young adult-aged patients. Questions/purposes We assessed cell-based surgical therapy for patellar osteochondritis dissecans (OCD) in adolescents and young adults by (1) determining function with the International Knee Documentation Committee (IKDC) subjective and Lysholm-Gillquist scores; and (2) evaluating activity level using the Tegner-Lysholm scale. Methods We retrospectively reviewed 23 patients between 12 and 21 years of age (mean 16.8 years) treated for OCD lesions involving the patella from 2001 to 2008. Twenty patients had autologous chondrocyte implantation and three patients had cultured bone marrow stem cell implantation. There were 19 males and four females. We obtained preoperative CT scans to assess patella subluxation, tilt, and congruence angle to determine choice of treatment. We obtained IKDC subjective knee evaluation scores, Tegner-Lysholm activity levels, and LysholmGillquist knee scores preoperatively and at 6, 12, and 24 months postoperatively. Results Mean IKDC score, Tegner-Lysholm outcomes, and Lysholm-Gillquist scale improved from 45, 2.5, and 50, respectively, at surgery to 75, 4, and 70, respectively, at 24-month followup. Complications include periosteal hypertrophy observed in two patients. Conclusion Cell-based therapy was associated with shortterm improvement in function in adolescents and young adults with patellar

Autologous osteochondral mosaicplasty in osteochondritis dissecans of the patella in adolescents

“…The fixation of loose fragments with Herbert screws [11] or resorbable pins [12] is not free from complications such as synovitis or fractures of the screws with a loose body in the joint, which leads to joint degradation [26][27][28]. Most recently, the results of autologous chondrocyte implantation which produces a cartilage similar to the hyaline cartilage was reported [29]. Macmull [30] showed that symptomatic chondromalacia patellae lesions improved with chondrocyte implantation, especially in patients who received matrix assisted chondrocyte implantation technique (MACI).…”

Cell Therapy in Joint Disorders

“…Surgical implantation may be similar to ACI, with MSCs beneath a periosteal 119 or collagen 43 cover instead of cultured chondrocytes. 45 , 60 , 67 , 74 , 84 , 103 , 104 , 109 , 119 - 123 A cell-seeded construct (analogous to MACI) may be used rather than suspended cells. 11 An ideal scaffold is nontoxic, absorbable, mechanically sound, and promotes cell growth.…”

Mesenchymal stem cells in the treatment of traumatic articular cartilage defects: a comprehensive review

“…Cells derived from autologous bone marrow aspirates from the iliac crest have been used for treatment of focal, traumatic chondral and osteochondral defects of the femoral condyle [ 81 – 87 ], femoral trochlea [ 84 , 88 , 89 ], talus [ 80 , 90 , 91 ], tibial plateau [ 89 ], and patella [ 84 , 88 , 89 ]. Other studies have addressed the use of this technique in managing other defect types, such as osteochondral lesions arising from osteochondritis dissecans [ 92 , 93 ], septic arthritis [ 94 ] and unicompartmental OA [ 95 ].…”

“…Following aspiration, MSCs were isolated and expanded within the laboratory for 2 to 3 weeks and implanted alone [ 84 , 93 ] or in association with biomaterial matrices [ 82 , 83 , 85 , 88 ]. Alternatively, in other studies, BMDCs - also described as bone marrow concentrate [ 86 , 87 ] or bone marrow aspirate concentrate [ 89 ] - were separated using centrifugation systems [ 80 , 81 , 86 , 87 , 89 – 91 ].…”