Intermediate- to Long-Term Results of Combined Anterior Cruciate Ligament Reconstruction and Autologous Chondrocyte Implantation

Abstract

Background:Cartilage injury associated with anterior cruciate ligament (ACL) ruptures is common; however, relatively few reports exist on concurrent cartilage repair with ACL reconstruction. Autologous chondrocyte implantation (ACI) has been utilized successfully for treatment of moderate to large chondral defects.Hypothesis:ACL insufficiency with relatively large chondral defects may be effectively managed with concurrent ACL reconstruction and ACI.Study Design:Case series; Level of evidence, 4.Methods:Patients undergoing concurrent ACL primary or revision reconstruction with ACI of single or multiple cartilage defects were prospectively evaluated for a minimum 2 years. Pre- and postoperative outcome measures included the modified Cincinnati Rating Scale (MCRS), Western Ontario and McMaster Universities Osteoarthritis Index, visual analog pain scales, and postsurgery satisfaction surveys. ACI graft failure or persistent pain without functional improvement were considered treatment failures.Results:Twenty-six patients were included, with 13 primary and 13 revision ACL reconstructions performed. Mean defect total surface area was 8.4 cm2, with a mean follow-up of 95 months (range, 24-240 months). MCRS improved from 3.62 ± 1.42 to 5.54 ± 2.32, Western Ontario and McMaster Universities Osteoarthritis Index from 45.31 ± 17.27 to 26.54 ± 17.71, and visual analog pain scale from 6.19 ± 1.27 to 3.65 ± 1.77 (all Ps <.001). Eight patients were clinical failures, 69% of patients were improved at final follow-up, and 92% stated they would likely undergo the procedure again. No outcome correlation was found with regard to age, body mass index, sex, defect size/number, follow-up time, or primary versus revision ACL reconstruction. In subanalysis, revision ACL reconstructions had worse preoperative MCRS scores and greater defect surface areas. However, revision MCRS score improvements were greater, resulting in similar final functional scores when compared with primary reconstructions.Conclusion:Challenging cases of ACL tears with large chondral defects treated with concurrent ACL reconstruction and ACI can lead to moderately improved pain and function at long-term follow-up. Factors associated with clinical failure are not clear. When combined with ACI, patients undergoing revision ACL reconstructions have worse function preoperatively compared with those undergoing primary reconstructions but have similar final outcomes.

Revision Surgery After Cartilage Repair: Data From the German Cartilage Registry (KnorpelRegister DGOU)

“…The findings in this cohort, however, support previous reports that joint abnormalities treated simultaneously with cartilage repair surgery lead to satisfactory outcomes when compared with cartilage therapy alone. 2,26 One of the most important findings of this study was the sex-dependent occurrence of revision surgeries. A previous study found inferior results for female patients after ACI.…”

“…The findings in this cohort, however, support previous reports that joint abnormalities treated simultaneously with cartilage repair surgery lead to satisfactory outcomes when compared with cartilage therapy alone. 2 , 26 …”

Large osteochondral defect in the lateral femoral condyle reconstructed by Atelocollagen-associated autologous chondrocyte implantation combined with anterior cruciate ligament reconstruction

“…Dhinsa et al reported that ACI in combination with ACL reconstruction is a feasible option with similar results as those patients who have had the procedures staged and prioritized a combined strategy in terms of cost and a short rehabilitation period [ 21 ]. Pike et al reported improved clinical outcomes of eighteen out of twenty-six patients with concurrent ACI and either primary or revision ACL reconstruction with a mean follow-up of 7 years and concluded that ACI can contribute to moderately improved pain and function during a long-term follow-up [ 23 ]. Adachi et al reported an osteochondral lesion (15 × 15 mm) on the lateral femoral condyle reconstructed by the transplantation of tissue-engineered cartilage combined with an iliac bone graft [ 34 ].…”

“…Several issues need to be considered when making treatment decision for a full-thickness cartilage defect with an ACL injured knee. Only a few studies have described a combined treatment of osteochondral defects with ACL injured knee using autologous osteochondral grafting, autologous periosteum, periosteum-covered ACI, or MACI [ 20 – 23 ]. Although a combined treatment using ACI with ACL reconstruction seems to be one of the most useful options, there has been no previous report about a case of ACL injured knee with a huge depression fracture extending to the lateral wall of the femoral condyle.…”

Autologous Chondrocyte Implantation for Bipolar Chondral Lesions in the Tibiofemoral Compartment

“…Others have reported comparable outcomes when ACI was performed with those concomitant procedures. 16,47,53,55 Finally, we were not able to review all radiographs despite our efforts.…”