Download PDF
J Knee Surg 2018; 31(03): 212-226
DOI: 10.1055/s-0037-1607294
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patellofemoral Cartilage Restoration: Indications, Techniques, and Outcomes of Autologous Chondrocytes Implantation, Matrix-Induced Chondrocyte Implantation, and Particulated Juvenile Allograft Cartilage

Betina B. Hinckel
1   Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
,
Andreas H. Gomoll
2   Cartilage Repair Center, Brigham and Women's Hospital, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

29 April 2017

25 August 2017

Publication Date:
16 October 2017 (online)

    Permissions and Reprints

Abstract

Focal chondral defects are common in the patellofemoral (PF) joint and can significantly impair the quality of life. The autologous chondrocytes implantation (ACI) technique has evolved over the past 20 years: the first-generation technique involves the use of a periosteal patch, the second-generation technique (collagen-cover) uses a type I/III collagen membrane, and the newest third-generation technique seeds and cultivates the collagen membrane with chondrocytes prior to implantation and is referred to as matrix-induced autologous chondrocyte implantation. Particulated juvenile allograft cartilage (PJAC) (DeNovo NT) is minced cartilage allograft from juvenile donors. A thorough physical exam is important, especially for issues affecting the PF joint, to isolate the location and source of pain, and to identify associated pathologies. Imaging studies allow further characterization of the lesions and identification of associated pathologies and alignment. Conservative management should be exhausted before proceeding with surgical treatment. Steps of surgical treatment are diagnostic arthroscopy and biopsy, chondrocytes culture and chondrocyte implantation for the three generations of ACI, and diagnostic arthroscopy and implantation for PJAC. The techniques and their outcomes will be discussed in this article.

Keywords

knee - patellofemoral - patella - trochlear - cartilage - cartilage repair - ACI - MACI - particulated - transplantation - autologous - chondrocytes - cartilage - articular - DeNovo NT
 

  • References

  • 1 Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 1997; 13 (04) 456-460
    CrossrefPubMedGoogle Scholar
  • 2 Arøen A, Løken S, Heir S. , et al. Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med 2004; 32 (01) 211-215
    CrossrefPubMedGoogle Scholar
  • 3 Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 1994; 331 (14) 889-895
    CrossrefPubMedGoogle Scholar
  • 4 Behrens P, Bitter T, Kurz B, Russlies M. Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)--5-year follow-up. Knee 2006; 13 (03) 194-202
    CrossrefPubMedGoogle Scholar
  • 5 Gomoll AH, Yoshioka H, Watanabe A, Dunn JC, Minas T. Preoperative measurement of cartilage defects by MRI underestimates lesion size. Cartilage 2011; 2 (04) 389-393
    CrossrefPubMedGoogle Scholar
  • 6 Farr J, Yao JQ. Chondral defect repair with particulated juvenile cartilage allograft. Cartilage 2011; 2 (04) 346-353
    CrossrefPubMedGoogle Scholar
  • 7 Bonasia DE, Martin JA, Marmotti A. , et al. Cocultures of adult and juvenile chondrocytes compared with adult and juvenile chondral fragments: in vitro matrix production. Am J Sports Med 2011; 39 (11) 2355-2361
    CrossrefPubMedGoogle Scholar
  • 8 Farr J, Cole BJ, Sherman S, Karas V. Particulated articular cartilage: CAIS and DeNovo NT. J Knee Surg 2012; 25 (01) 23-29
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Riboh JC, Cole BJ, Farr J. Particulated articular cartilage for symptomatic chondral defects of the knee. Curr Rev Musculoskelet Med 2015; 8 (04) 429-435
    CrossrefPubMedGoogle Scholar
  • 10 Mandelbaum B, Browne JE, Fu F. , et al. Treatment outcomes of autologous chondrocyte implantation for full-thickness articular cartilage defects of the trochlea. Am J Sports Med 2007; 35 (06) 915-921
    CrossrefPubMedGoogle Scholar
  • 11 Vasiliadis HS, Lindahl A, Georgoulis AD, Peterson L. Malalignment and cartilage lesions in the patellofemoral joint treated with autologous chondrocyte implantation. Knee Surg Sports Traumatol Arthrosc 2011; 19 (03) 452-457
    CrossrefPubMedGoogle Scholar
  • 12 Bartlett W, Skinner JA, Gooding CR. , et al. Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 2005; 87 (05) 640-645
    CrossrefPubMedGoogle Scholar
  • 13 Ebert JR, Fallon M, Smith A, Janes GC, Wood DJ. Prospective clinical and radiologic evaluation of patellofemoral matrix-induced autologous chondrocyte implantation. Am J Sports Med 2015; 43 (06) 1362-1372
    CrossrefPubMedGoogle Scholar
  • 14 Pestka JM, Feucht MJ, Porichis S, Bode G, Südkamp NP, Niemeyer P. Return to sports activity and work after autologous chondrocyte implantation of the knee: which factors influence outcomes?. Am J Sports Med 2016; 44 (02) 370-377
    CrossrefPubMedGoogle Scholar
  • 15 Farr J, Tabet SK, Margerrison E, Cole BJ. Clinical, radiographic, and histological outcomes after cartilage repair with particulated juvenile articular cartilage: a 2-year prospective study. Am J Sports Med 2014; 42 (06) 1417-1425
    CrossrefPubMedGoogle Scholar
  • 16 Krych AJ, Pareek A, King AH, Johnson NR, Stuart MJ, Williams III RJ. Return to sport after the surgical management of articular cartilage lesions in the knee: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2016; DOI: 10.1007/s00167-016-4262-3.
    PubMedGoogle Scholar
  • 17 Oussedik S, Tsitskaris K, Parker D. Treatment of articular cartilage lesions of the knee by microfracture or autologous chondrocyte implantation: a systematic review. Arthroscopy 2015; 31 (04) 732-744
    CrossrefPubMedGoogle Scholar
  • 18 DiBartola AC, Wright BM, Magnussen RA, Flanigan DC. Clinical outcomes after autologous chondrocyte implantation in adolescents' knees: a systematic review. Arthroscopy 2016; 32 (09) 1905-1916
    CrossrefPubMedGoogle Scholar
  • 19 Mouzopoulos G, Borbon C, Siebold R. Patellar chondral defects: a review of a challenging entity. Knee Surg Sports Traumatol Arthrosc 2011; 19 (12) 1990-2001
    CrossrefPubMedGoogle Scholar
  • 20 Noyes FR, Barber-Westin SD. Advanced patellofemoral cartilage lesions in patients younger than 50 years of age: is there an ideal operative option?. Arthroscopy 2013; 29 (08) 1423-1436
    CrossrefPubMedGoogle Scholar
  • 21 Kreuz PC, Steinwachs MR, Erggelet C. , et al. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage 2006; 14 (11) 1119-1125
    CrossrefPubMedGoogle Scholar
  • 22 Niemeyer P, Porichis S, Steinwachs M. , et al. Long-term outcomes after first-generation autologous chondrocyte implantation for cartilage defects of the knee. Am J Sports Med 2014; 42 (01) 150-157
    CrossrefPubMedGoogle Scholar
  • 23 Minas T, Von Keudell A, Bryant T, Gomoll AH. The John Insall Award: a minimum 10-year outcome study of autologous chondrocyte implantation. Clin Orthop Relat Res 2014; 472 (01) 41-51
    CrossrefPubMedGoogle Scholar
  • 24 Peterson L, Vasiliadis HS, Brittberg M, Lindahl A. Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med 2010; 38 (06) 1117-1124
    CrossrefPubMedGoogle Scholar
  • 25 Gomoll AH, Gillogly SD, Cole BJ. , et al. Autologous chondrocyte implantation in the patella: a multicenter experience. Am J Sports Med 2014; 42 (05) 1074-1081
    CrossrefPubMedGoogle Scholar
  • 26 Macmull S, Jaiswal PK, Bentley G, Skinner JA, Carrington RW, Briggs TW. The role of autologous chondrocyte implantation in the treatment of symptomatic chondromalacia patellae. Int Orthop 2012; 36 (07) 1371-1377
    CrossrefPubMedGoogle Scholar
  • 27 Farr J. Autologous chondrocyte implantation improves patellofemoral cartilage treatment outcomes. Clin Orthop Relat Res 2007; 463 (463) 187-194
    CrossrefPubMedGoogle Scholar
  • 28 Minas T, Bryant T. The role of autologous chondrocyte implantation in the patellofemoral joint. Clin Orthop Relat Res 2005; (436) 30-39
    PubMedGoogle Scholar
  • 29 Pascual-Garrido C, Slabaugh MA, L'Heureux DR, Friel NA, Cole BJ. Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: prospective evaluation at average 4-year follow-up. Am J Sports Med 2009; 37 (Suppl. 01) 33S-41S
    PubMedGoogle Scholar
  • 30 Gigante A, Enea D, Greco F. , et al. Distal realignment and patellar autologous chondrocyte implantation: mid-term results in a selected population. Knee Surg Sports Traumatol Arthrosc 2009; 17 (01) 2-10
    CrossrefPubMedGoogle Scholar
  • 31 Gillogly SD, Arnold RM. Autologous chondrocyte implantation and anteromedialization for isolated patellar articular cartilage lesions: 5- to 11-year follow-up. Am J Sports Med 2014; 42 (04) 912-920
    CrossrefPubMedGoogle Scholar
  • 32 Henderson IJ, Lavigne P. Periosteal autologous chondrocyte implantation for patellar chondral defect in patients with normal and abnormal patellar tracking. Knee 2006; 13 (04) 274-279
    CrossrefPubMedGoogle Scholar
  • 33 Vanlauwe JJ, Claes T, Van Assche D, Bellemans J, Luyten FP. Characterized chondrocyte implantation in the patellofemoral joint: an up to 4-year follow-up of a prospective cohort of 38 patients. Am J Sports Med 2012; 40 (08) 1799-1807
    CrossrefPubMedGoogle Scholar
  • 34 Buckwalter JA, Bowman GN, Albright JP, Wolf BR, Bollier M. Clinical outcomes of patellar chondral lesions treated with juvenile particulated cartilage allografts. Iowa Orthop J 2014; 34: 44-49
    PubMedGoogle Scholar
  • 35 Meyerkort D, Ebert JR, Ackland TR. , et al. Matrix-induced autologous chondrocyte implantation (MACI) for chondral defects in the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2522-2530
    CrossrefPubMedGoogle Scholar
  • 36 Trinh TQ, Harris JD, Siston RA, Flanigan DC. Improved outcomes with combined autologous chondrocyte implantation and patellofemoral osteotomy versus isolated autologous chondrocyte implantation. Arthroscopy 2013; 29 (03) 566-574
    CrossrefPubMedGoogle Scholar
  • 37 Niemeyer P, Steinwachs M, Erggelet C. , et al. Autologous chondrocyte implantation for the treatment of retropatellar cartilage defects: clinical results referred to defect localisation. Arch Orthop Trauma Surg 2008; 128 (11) 1223-1231
    CrossrefPubMedGoogle Scholar
  • 38 Gobbi A, Kon E, Berruto M, Francisco R, Filardo G, Marcacci M. Patellofemoral full-thickness chondral defects treated with Hyalograft-C: a clinical, arthroscopic, and histologic review. Am J Sports Med 2006; 34 (11) 1763-1773
    CrossrefPubMedGoogle Scholar
  • 39 Gobbi A, Kon E, Berruto M. , et al. Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: results at 5 years' follow-up. Am J Sports Med 2009; 37 (06) 1083-1092
    CrossrefPubMedGoogle Scholar
  • 40 Ebert JR, Robertson WB, Woodhouse J. , et al. Clinical and magnetic resonance imaging-based outcomes to 5 years after matrix-induced autologous chondrocyte implantation to address articular cartilage defects in the knee. Am J Sports Med 2011; 39 (04) 753-763
    CrossrefPubMedGoogle Scholar
  • 41 Bentley G, Biant LC, Carrington RW. , et al. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br 2003; 85 (02) 223-230
    Google Scholar
  • 42 Cvetanovich GL, Riboh JC, Tilton AK, Cole BJ. Autologous chondrocyte implantation improves knee-specific functional outcomes and health-related quality of life in adolescent patients. Am J Sports Med 2017; 45 (01) 70-76
    CrossrefPubMedGoogle Scholar
  • 43 Rosenberger RE, Gomoll AH, Bryant T, Minas T. Repair of large chondral defects of the knee with autologous chondrocyte implantation in patients 45 years or older. Am J Sports Med 2008; 36 (12) 2336-2344
    CrossrefPubMedGoogle Scholar
  • 44 Nawaz SZ, Bentley G, Briggs TW. , et al. Autologous chondrocyte implantation in the knee: mid-term to long-term results. J Bone Joint Surg Am 2014; 96 (10) 824-830
    CrossrefPubMedGoogle Scholar
  • 45 van Jonbergen HP, Poolman RW, van Kampen A. Isolated patellofemoral osteoarthritis. Acta Orthop 2010; 81 (02) 199-205
    CrossrefPubMedGoogle Scholar
  • 46 Goyal D, Goyal A, Keyhani S, Lee EH, Hui JH. Evidence-based status of second- and third-generation autologous chondrocyte implantation over first generation: a systematic review of level I and II studies. Arthroscopy 2013; 29 (11) 1872-1878
    CrossrefPubMedGoogle Scholar
  • 47 Bonner KF, Daner W, Yao JQ. 2-year postoperative evaluation of a patient with a symptomatic full-thickness patellar cartilage defect repaired with particulated juvenile cartilage tissue. J Knee Surg 2010; 23 (02) 109-114
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Teo BJ, Buhary K, Tai BC, Hui JH. Cell-based therapy improves function in adolescents and young adults with patellar osteochondritis dissecans. Clin Orthop Relat Res 2013; 471 (04) 1152-1158
    CrossrefPubMedGoogle Scholar
  • 49 Tompkins M, Hamann JC, Diduch DR. , et al. Preliminary results of a novel single-stage cartilage restoration technique: particulated juvenile articular cartilage allograft for chondral defects of the patella. Arthroscopy 2013; 29 (10) 1661-1670
    CrossrefPubMedGoogle Scholar
  • 50 McNickle AG, L'Heureux DR, Yanke AB, Cole BJ. Outcomes of autologous chondrocyte implantation in a diverse patient population. Am J Sports Med 2009; 37 (07) 1344-1350
    CrossrefPubMedGoogle Scholar
  • 51 Bentley G, Biant LC, Vijayan S, Macmull S, Skinner JA, Carrington RW. Minimum ten-year results of a prospective randomised study of autologous chondrocyte implantation versus mosaicplasty for symptomatic articular cartilage lesions of the knee. J Bone Joint Surg Br 2012; 94 (04) 504-509
    Google Scholar