Patellofemoral Chondral Defects Treated with 2nd Generation ACI: A Clinical Review at 6 Years (SS-60)

Abstract

Patellofemoral lesions are difficult to treat, however, authors hypothesized that Second generation ACI could be a viable treatment for patellofemoral Grade III-IV chondral lesions. The aim of this study was to test the efficacy of Second generation ACI in treating full-thickness patellofemoral defects and report results at six years. In this prospective non-randomized controlled study, 34 patients with patellofemoral chondral lesions, mean size of 4.45 cm2, were followed up. Lesions were classified as ICRS grade IV A or B (76.47%), grade IIIC (14.70%) and secondary to OCD (8.82%). Grafts were implanted through a mini-incision approach (25) or arthroscopically (9). Results were evaluated using the ICRS IKDC 2000 subjective and objective scores, EuroQol VAS, and Tegner scores at pre-op, 2 and 6 yrs. Statistical analysis was performed using the paired T test and Wilcoxon signed rank test. All scores demonstrated a statistically significant improvement (P < .0001) at 6 years from pre-op. Objective preoperative data improved from 8/34 (23.52%) with IKDC A or B scores to 30/34 (88.22%) IKDC A or B scores at 6 years. Mean IKDC subjective scores improved from 46.09 points preoperatively to 70.39 points 6 years after implantation. Tegner improved from 2.56 to 4.68. EQ VAS scores improved from 54.81 to 78.24. Second generation ACI can be a viable treatment for patellofemoral chondral lesions. Long-term investigations (10 years) are needed to determine the durability of the repair produced with this technique.