Revision cartilage cell transplantation for failed autologous chondrocyte transplantation in chronic osteochondral defects of the knee

Abstract

The management of failed autologous chondrocyte implantation (ACI) and matrix-assisted autologous chondrocyte implantation (MACI) for the treatment of symptomatic osteochondral defects in the knee represents a major challenge. Patients are young, active and usually unsuitable for prosthetic replacement. This study reports the results in patients who underwent revision cartilage transplantation of their original ACI/MACI graft for clinical or graft-related failure. We assessed 22 patients (12 men and 10 women) with a mean age of 37.4 years (18 to 48) at a mean of 5.4 years (1.3 to 10.9). The mean period between primary and revision grafting was 46.1 months (7 to 89). The mean defect size was 446.6 mm(2) (150 to 875) and they were located on 11 medial and two lateral femoral condyles, eight patellae and one trochlea. The mean modified Cincinnati knee score improved from 40.5 (16 to 77) pre-operatively to 64.9 (8 to 94) at their most recent review (p < 0.001). The visual analogue pain score improved from 6.1 (3 to 9) to 4.7 (0 to 10) (p = 0.042). A total of 14 patients (63%) reported an 'excellent' (n = 6) or 'good' (n = 8) clinical outcome, 5 'fair' and one 'poor' outcome. Two patients underwent patellofemoral joint replacement. This study demonstrates that revision cartilage transplantation after primary ACI and MACI can yield acceptable functional results and continue to preserve the joint.

Revision surgery after third generation autologous chondrocyte implantation in the knee

“…This complication rate involves only patients after first generation ACI in the knee joint [24]. Vijayan et al showed the revision cartilage transplantation after primary ACI can yield acceptable functional results [25].…”

Treatment of osteochondral lesions in the knee using a cell-free scaffold

“…9 Further, autologous chondrocyte implantation is not universally successful. 10 Recently, there has been interest in the role of subchondral bone in cartilage repair. Careful consideration of subchondral bone in the treatment of articular surface damage is required when evaluating the results over time.…”

How to Manage a Failed Cartilage Repair: A Systematic Literature Review

“…Vijayan et al 34 described their experience with revision cartilage surgery in patients with isolated chondral or osteochondral defect after failed ACI or MACI. The study population was composed of 22 patients (mean defect size, 4.46 cm 2 ) with a mean follow-up of 5.4 years.…”