Intralesional Osteophyte Regrowth Following Autologous Chondrocyte Implantation after Previous Treatment with Marrow Stimulation Technique

Abstract

Objective. Bone marrow stimulation surgeries are frequent in the treatment of cartilage lesions. Autologous chondrocyte implantation (ACI) may be performed after failed microfracture surgery. Alterations to subchondral bone as intralesional osteophytes are commonly seen after previous microfracture and removed during ACI. There have been no reports on potential recurrence. Our purpose was to evaluate the incidence of intralesional osteophyte development in 2 cohorts: existing intralesional osteophytes and without intralesional osteophytes at the time of ACI. Study Design. We identified 87 patients (157 lesions) with intralesional osteophytes among a cohort of 497 ACI patients. Osteophyte regrowth was analyzed on magnetic resonance imaging and categorized as small or large (less or more than 50% of the cartilage thickness). Twenty patients (24 defects) without intralesional osteophytes at the time of ACI acted as control. Results. Osteophyte regrowth was observed in 39.5% of lesions (34.4% of small osteophytes and 5.1% of large osteophytes). In subgroup analyses, regrowth was observed in 45.8% of periosteal-covered defects and in 18.9% of collagen membrane-covered defects. Large osteophyte regrowth occurred in less than 5% in either group. Periosteal defects showed a significantly higher incidence for regrowth of small osteophytes. In the control group, intralesional osteophytes developed in 16.7% of the lesions. Conclusions. Even though intralesional osteophytes may regrow after removal during ACI, most of them are small. Small osteophyte regrowth occurs almost twice in periosteum-covered ACI. Large osteophytes occur only in 5% of patients. Intralesional osteophyte formation is not significantly different in preexisting intralesional osteophytes and control groups.

Outcomes and clinical role of osteochondral allograft transplantation

“…Others have shown that previous subchondral marrow stimulation techniques do not affect the outcomes of OAT when comparing patients who received marrow stimulating techniques prior to OAT with patients who did not (10). This study further demonstrates that previous cartilage repair surgeries do not affect primary OAT outcomes, in comparison to ACI, in which previous marrow stimulation prior to ACI results in increased failure rates (11,12).…”

An Expert Consensus Statement on the Management of Large Chondral and Osteochondral Defects in the Patellofemoral Joint

“…7,35,78 Even though the sandwich technique has been described in the treatment of bone lesions concomitantly with ACI, there was no agreement on its utilization, and OCA was preferred for cases that include intralesional osteophytes, revision including prior failed microfracture, prior fracture malunion, significant subchondral stress reactions also known as "bone edema," significant subchondral cyst formation, and bone loss due to fractures or osteochondritis dissecans fragment excision. 21,31,36,38,60,62,75,79 In the patellofemoral joint, morphology matching makes OCA technically more demanding than ACI. This is because of the complex topography, with highly variable shapes of the patella and trochlea.…”

Surgical osteochondral defect repair in the horse—a matter of form or function?

“…A large systematic review on microfracture for the treatment of osteochondral defects in the knee in human patients showed that in most cases clinical outcomes improved with microfracture at short‐term, but in some studies and over the longer term these effects were not sustained . One of the negative outcomes appears to be the formation of intralesional osteophytes . This might represent further degeneration of repair fibrocartilage triggering a reactivation of the endochondral ossification mechanism once the subchondral bone plate is perforated .…”