To compare short-term patient-reported outcomes (PROMs) and revision rates between autologous hand-minced cartilage implantation (MCI) and autologous chondrocyte implantation (ACI) for knee cartilage lesions. All patients undergoing MCI or ACI at a single centre were retrospectively analysed from a prospectively maintained database. Propensity score matching was performed based on age, defect localisation, defect size, general health status (ASA class), and prior surgery. PROMs, including the COMI, IKDC score and VAS for pain, were obtained preoperatively and at 6, 12, and 24 months postoperatively. Statistical comparisons were performed for PROM absolute values, improvement from baseline, Patient Acceptable Symptom State (PASS) and Maximum Outcome Improvement (MOI). Postoperative complications and revision surgeries were also compared. After matching, 25 patients per group were compared. Both groups demonstrated statistically significant improvements in all PROMs when compared against baseline: COMI scores improved from 5.0 ± 1.5 to 2.6 ± 2.0 for ACI and from 5.3 ± 1.7 to 2.0 ± 2.0 for MCI. IKDC scores improved for ACI (49.8 ± 14.0 to 71.3 ± 18.7, p < .001) and MCI (49.4 ± 15.8 to 74.3 ± 15.9, p < 0.001). The VAS score for pain decreased significantly for both ACI (5.0 ± 2.2 to 2.2 ± 2.1, p < 0.001) and MCI (4.2 ± 2.5 to 2.2 ± 2.0, p < 0.001). ACI and MCI differed neither statistically nor clinically in PROMs. Gender, defect localisation, defect size, and concomitant interventions had no substantial influence on outcomes. Overall, 60% and 68% of ACI patients and 68% and 80% of MCI patients achieved PASS for IKDC and COMI scores at 24 months (p = n.s.). Re-operation rates were comparable between both groups. Patients undergoing single-stage MCI or two-stage ACI for medium to large knee chondral defects achieve comparable and favourable short-term outcomes with low rates for adverse event. MCI is an efficient and effective alternative treatment option for patients seeking a single-stage solution or in areas where ACI is inaccessible. Level III.

Treatment options and outcomes for paediatric knee cartilage lesions: a systematic review.

High-grade trochlear dysplasia is associated with a more negative sagittal tibial tuberosity-trochlear groove distance: A retrospective cohort study.

Dataset on patient education and digital information quality in knee cartilage restoration with matrix-induced autologous chondrocyte implantation (MACI)

ObjectiveThis study aimed to evaluate clinical outcomes and cartilage repair following autologous chondrocyte implantation (ACI) combined with high tibial osteotomy (HTO) in elderly patients with spontaneous osteonecrosis of the knee (SONK) presenting with large cartilage defects.DesignEleven knees of 11 patients with SONK (lesion size ≥4 cm2) aged 60 years or older underwent ACI and concomitant opening-wedge HTO. Patients were followed for at least 1 year. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Cartilage repair was evaluated arthroscopically using the International Cartilage Repair Society (ICRS) grade and histologically using the ICRS II score at second-look arthroscopy.ResultsThe overall KOOS improved significantly from a preoperative value of 38.4 ± 8.5 to a 1-year postoperative value of 77.8 ± 10.9 (P < 0.01). Arthroscopy showed cartilage repair to normal or nearly normal in 91% of cases. The mean histological ICRS II score was 67.5 ± 16.2. No postoperative complications or need for additional surgical interventions was observed.ConclusionsACI combined with HTO provides good clinical and histological outcomes in elderly patients with SONK and large cartilage defects. This approach represents an effective joint-preserving treatment option, even in patients aged 60 years or older.

Online information on MACI knee surgery: analysis and opportunities to improve patient education and decision-making.

The effects of hypothermic storage on passaged chondrocyte viability and redifferentiation potential.

Around 10,000 symptomatic knee articular cartilage injuries requiring repair occur annually in the United Kingdom, mostly in people under 35 years of age. Microfracture surgery aims to restore cartilage. Adding microstructural scaffolds made of collagen may further improve outcomes. To evaluate the clinical and cost-effectiveness of microstructural scaffold in patients undergoing microfracture for a symptomatic chondral or osteochondral defect of the knee. Multicentre, parallel two-group, superiority randomised controlled trial with blinding of participants, research staff and clinical care teams not involved in the surgery. National Health Service hospitals offering arthroscopic chondral surgery. Adults aged 18 years or older with symptomatic chondral or osteochondral defects of the knee on the medial or lateral femoral condyles, trochlea or patella and a chondral or osteochondral lesion measuring no more than 4 cm2. Exclusions were: unstable ligamentous injuries or meniscal tears that would not be treated; a knee with defects on the tibial chondral surface, < 50% native meniscal volume or requiring realignment surgery/osteotomy; and a lesion previously treated with microfracture. Lesions were debrided, and microfracture was performed on the exposed subchondral bone. Intervention: microfracture of the chondral or osteochondral lesion with insertion of a bilayer collagen matrix microstructural scaffold, fixed with stiches or fibrin glue. Comparator: microfracture alone. Postoperative physiotherapy was standardised. Participants were randomised 1 : 1 between intervention and control. Primary outcome was the Knee Injury and Osteoarthritis Outcome Score at 24 months post randomisation. Secondary outcomes included International Knee Documentation Committee knee evaluation score; Tegner-Lysholm activity grading scale; EuroQol-5 Dimensions, five-level version; Work Productivity and Activity Impairment; complications and resource use measured at 3, 6, 12 and 24 months. Twenty-two patients were screened across 8 sites, 20 of whom were eligible on screening. Of the 20 patients considered initially eligible, 2 patients were not interested and 1 opted for chondroplasty; the remaining 17 all consented to participate. Between November 2021 and October 2022, 10 participants were randomised, 5 to microfracture and 5 to microfracture with scaffold. Three patients failed the final in-surgery eligibility check (lesions had healed), one decided not to have surgery and three were still waiting when the study was closed. The median age was 38 years, and four participants were female. Most participants (seven) had damage to the lateral femoral condyle, and six had a medial and/or lateral meniscal tear. All participants received the allocated treatment and are included in the reported results. When a scaffold was used, the surgery took on average 10 minutes longer. There were three serious adverse events, knee pain and swelling in one participant, and a suspected anaphylactic reaction in another. The SISMIC randomised controlled trial did not progress beyond the internal pilot phase due to insufficient recruitment. The target number of sites were opened, but recruitment was only 42% of the target 24 participants randomised. Insufficient data were collected to answer the research question. The SISMIC randomised controlled trial was severely impacted by the COVID-19 pandemic, the limited resources available at sites and the reduced elective orthopaedic surgical activity. To reflect contemporary practice, we recommend that a future trial evaluates three treatments: chondroplasty, chondroplasty with a microstructural scaffold and autologous chondrocyte implantation. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR127849.

Cartilage damage affects 25 million people globally each year. Tissue engineering strategies such as microfracture and matrix induced autologous chondrocyte implantation (MACI) are currently being used in the clinic; however, they are accompanied by their own limitations such as donor site morbidity, rapid clearance from the injury site, and extensive cost. To overcome these limitations, the tissue engineering field has shown increasing interest in the use of decellularized extracellular matrix (dECM) biomaterials due to their heightened integration with native tissue and regeneration rates. The Gottardi Lab has developed a new dECM material sourced from porcine men iscus d ecellularization (MEND), in which elastin fibers are removed via enzymatic digestion, resulting in channels that can be easily recellularized. In this work we demonstrate that MEND can be seeded with bone-marrow derived mesenchymal stem cells (MSCs), achieving a uniform distribution of cell nuclei throughout the cross section of the scaffold. We also show that MEND retains its native structure in the presence of MSCs and can support chondrogenesis comparably to other commonly used tissue engineering materials such as methacrylated type I collagen and gelatin/hyaluronic acid hydrogels. Overall, MEND is a promising new dECM biomaterial for cartilage regeneration.

This study aimed to evaluate the radiological and patient-reported outcome measures (PROMs) following spheroid-based matrix-induced autologous chondrocyte implantation combined with autologous bone grafting (MABCI) for the treatment of osteochondral defects of the knee. In this retrospective cohort analysis of prospectively collected data, 28 consecutive patients with 29 defects of the femoral condyle (male: 15, female: 13, mean age 27.3 ± 9.8 years, mean defect size 3.7 ± 1.6 cm²) treated with MABCI were included. Radiological assessments were performed using 3T magnetic resonance imaging (MRI) to evaluate cartilage thickness, T2 relaxation times and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scores. Clinical outcomes were assessed using validated PROMs, including the International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Lysholm scale and the Patient-Reported Outcomes Measurement Information System 29-Item Profile (PROMIS-29). Correlation analyses were conducted to evaluate associations between radiological parameters and PROMs. The analysis was conducted at a mean follow-up of 44.4 ± 21.6 months. Cartilage thickness in the repair tissue exceeded that of the reference cartilage (3.4 ± 0.9 mm vs. 3.0 ± 0.5 mm; p = 0.036), while T2 relaxation times in the repair tissue were within physiological range (50.5 ± 40.0 ms vs. 41.3 ± 5.4 ms; n.s.). The mean MOCART 2.0 score was 61.3 ± 13.0 (volume fill: 16.1 ± 3.7, integration with adjacent cartilage: 12.9 ± 3.3), reflecting satisfactory repair quality. All clinical scores showed significant improvement compared to the preoperative condition (IKDC: 70.6 ± 13.2 vs. 54.8 ± 17.5, p < 0.001; KOOS: pain 78.7 ± 16.9 vs. 66.1 ± 18.6, p = 0.002, symptoms 75.6 ± 16.0 vs. 65.8 ± 19.1, p = 0.006, ADL 86.8 ± 14.0 vs. 77.6 ± 16.8, p = 0.003, sport 63.0 ± 24.2 vs. 47.3 ± 26.9, p = 0.009, quality of life (QoL) 51.0 ± 22.7 vs. 39.6 ± 17.5, p = 0.014; numeric pain rating scale: 3.0 ± 2.2 vs. 5.2 ± 2.4, p < 0.001). A greater cartilage thickness was associated with reduced pain intensity (r = -0.457, p = 0.013) and improved QoL (r = 0.429, p = 0.020), indicating that better structural repair is associated with improved patient satisfaction. MABCI results in satisfactory cartilage regeneration and subchondral remodelling in addition to significant improvements in patient satisfaction and overall QoL. Level III.

Purpose To systematically review return-to-sport (RTS) patient-reported outcome measure (PROM) usage following autologous chondrocyte implantation (ACI) and matrix-induced autologous chondrocyte implantation (MACI). We hypothesized that RTS reporting would be highly inconsistent, limiting clinical applicability. Methods A systematic review was conducted using PubMed, Embase, and Scopus (January 1, 2014–December 8, 2024). Eligible studies reported RTS PROMs after ACI/MACI. Extracted data included study design, demographics, name and type of scale used, and assessment modality. Results Of 807 studies screened, 85 met inclusion criteria. Measures used to report RTS varied widely. The Knee injury and Osteoarthritis Outcome Score–Sport/Rec and the International Knee Documentation Committee Subjective Knee Evaluation Form were the most commonly reported validated PROMs, included in 71.8% and 49.4% of studies, respectively. Only 15.3% of studies reported RTS as a postoperative percentage. Of all, 22.4% of studies used custom, nonvalidated tools. Most studies (49.4%) were prospective, and in-person evaluation was most common (52.8%). Timepoints of RTS measurement were inconsistent. Conclusions RTS is inconsistently quantified following ACI/MACI, limiting cross-study comparisons and complicating clinical interpretation of outcomes. Standardized use of and expansion of validated PROMs is needed to improve the clinical applicability of data on RTS for ACI/MACI

Review of Brittberg's article on the treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation: "The Classic".

Cartilage defects remain a prevalent and challenging clinical problem, especially in young, active individuals. Existing treatments such as microfracture or autologous chondrocyte implantation either lack durability or require multiple surgeries and extensive cell culture. To address these limitations, we developed RECLAIM-a one-stage, two-cell-type procedure combining allogeneic mesenchymal stromal cells and autologous chondrons. RECLAIM harnesses the trophic and immunomodulatory properties of MSCs to stimulate autologous chondron-driven tissue repair, minimizing invasiveness while optimizing biologic regeneration. This article reviews the preclinical discovery, clinical translation, trial results, and platform potential of RECLAIM, which was recognized with the 2025 Arnold I. Caplan Award for Distinguished Research in OrthoBiologics. Our work builds on Professor Caplan's pioneering conceptualization of MSCs as "medicinal signaling cells" and establishes a model for academic, investigator-driven translation of regenerative science into clinical practice.

Juvenile Knee Osteochondritis Dissecans.

Background:Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging outcomes in treating symptomatic knee cartilage lesions. Rehabilitation is imperative to optimize outcome, although it has been traditionally conservative.Purpose:To investigate the longer term clinical and radiological outcome of MACI and investigate any differences in outcome between patients randomized to a 6-week (vs 8-week) return to full weightbearing (WB) after MACI.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 35 patients were recruited into the study, though 37 knees (i.e. two patients had both knees inlcuded at different timepoints) were independently evaluated preoperatively and at 1, 2, 5, and 10 years after surgery. A comparison was made between recruited knees prospectively randomized to a 6-week (n = 18) or 8-week (n = 19) return to full WB after MACI. Patient-reported outcome measures (PROMs) were assessed utilizing the Knee injury and Osteoarthritis Outcome Score. Peak isokinetic knee extensor and flexor torque and single-leg hop capacity (single horizontal, lateral, and medial hop tests for distance) were assessed, with limb symmetry indices (LSIs) calculated. High-resolution magnetic resonance imaging (MRI) was undertaken at all postoperative time points to assess pertinent parameters of graft integrity as per the MOCART (magnetic resonance observation of cartilage repair tissue) system. A combined MRI composite score was also evaluated.Results:At 10 years after surgery, 31 knees (84%) were available for review, with 3 knees (6 weeks, n = 2; 8 weeks, n = 1) lost to follow-up and 3 knees (6 weeks, n = 1; 8 weeks, n = 2) having already had total knee arthroplasty (TKA) performed before 10 years. All PROMs (apart from the Mental Component Summary of the 36-item Short Form Health Survey [P = .57]) significantly improved (P < .0001) over the 10-year period, with no group differences (P > .05) observed. At 10 years, overall satisfaction was reported as 93% (6 weeks) and 88% (8 weeks). The peak knee extensor torque LSI significantly improved (P < .0001) over time, with mean LSIs of 100.8% (6 weeks) and 99.1% (8 weeks) at 10 years. No group differences (P > .05) were observed in hop test LSIs, with 10-year hop test LSIs ranging from 99.1% to 103.8%. No significant changes (P > .05) were observed for any graft parameter, or the MRI composite score, from 1-year to final 10-year review. Apart from a significant group effect (P = .03) for graft tissue intensity in favor of the 6-week group suggesting repair tissue more reflective of native cartilage, no other MRI-based differences (P > .05) were reported. At 10 years, 1 further graft (8 weeks) on MRI had failed and, combined with the 3 TKAs, an overall 10-year failure rate of 11.8% was observed.Conclusion:MACI provided sustained clinical and MRI-based outcomes in most patients to 10 years after surgery, with high satisfaction levels. The 6-week WB protocol did not jeopardize the early or longer term graft outcome.

Rheumatoid Arthritis (RA) and Osteoarthritis (OA) are among the most impactful musculoskeletal disorders causing articular cartilage degradation, ultimately leading to loss of the joint functionality. Matrix-assisted Autologous Chondrocytes Implantation (MACI) is one of the most promising reconstructive techniques to treat chondral defects (CDs). MACI relies on a matrix cellularized with autologous chondrocytes implanted directly onto cartilage defects. Despite MACI's effectiveness, post-surgery rehabilitation remains a challenge, as it fails to induce the optimal mechanobiology necessary for an effective cartilage regeneration. Additionally, there is a significant patient-to-patient variability and the local loads occurring during rehabilitation might consequently vary greatly. We propose a personalized approach focused on the delivery local pro-regenerative mechanobiological cues to dramatically improve the cartilage restoration after MACI.We developed an innovative scaffold to be used as matrix in MACI, capable to enhance the cartilage repair by delivering in situ controlled, and personalized, mechanical cues triggering pro-regenerative cellular responses to embedded human articular chondrocytes (hACs). The scaffold relies on an electrospun matrix made of aligned fibers composed of PVDF-TrFE, a piezoelectric polymer, enriched with ferromagnetic Fe3O4 nanoparticles capable to confer magnetic properties to the scaffold. MNPs were simultaneously dispersed in the polymeric solution, and microfibers were collected onto a high-speed rotating collector to obtain an aligned micropattern, capable to give mechanical anisotropy to the scaffold. After cellularization with hACs, we subjected the scaffold to daily magnetic stimulation up to 14 days.The scaffold was highly responsive to external magnetic stimuli. In addition, hACs produced a type II collagen-rich extracellular matrix when cultured within the scaffolds subjected to magnetic stimulation. Remarkably, we observed an increase of cell viability, and of type II/type X collagen ratio.Our scaffold was able to provide pro-regenerative cues to hACs after mechanical cyclic deformations induced by repeated magnetic stimulations. Such an approach paves the way to an effective, and definitive therapeutic procedure for the treatment of chondral defects.

Osteoarthritis (OA) is one of the most prevalent conditions in the world with approximately 600 million individuals, with cases expected to rise with people undertaking more rigorous and high-risk sporting activities, leading to trauma that can trigger the onset of the disease. Though OA is considered a whole joint disease, therapies have primarily focussed on regenerating articular cartilage. However, its pathogenesis can also arise as a secondary complication from meniscus tears, which alters joint biomechanics and increases exposure of the underlying articular cartilage.Thus, preservation of the surrounding tissues and treating articular cartilage are vital for early OA prevention.Regenerative medicine has yielded a variety of the cell or biomaterial-based strategies for the treatment of articular cartilage and meniscus, although clinical trials have shown mixed results. This is related to an understanding that different types of cartilage or meniscal lesions require a specific remedy, emphasising the need for a personalised medicine-based approach. In articular cartilage repair, cell-based therapies such as autologous chondrocyte implantation (ACI) often results in fibrocartilage formation, thereby necessitating the requirement for additional interventions. In the case of meniscus tears, collagen or PCU scaffolds can replace damaged tissue but long-term studies show that the scaffolds gradually degrade with time and do not provide superior chondroprotection compared to meniscectomy.Controlling the cellular fate in cell-based therapies and functionalising scaffolds with specific motifs have the potential to enhance current regenerative strategies for articular cartilage and meniscus, thereby improving long-term performance and clinical outcomes. This presentation will provide an overview of our work on how environmental stimuli influence chondrocyte and meniscal cell phenotypes and how scaffold functionalisation can potentially enhance its performance in a defect model for meniscus tears. Additionally, the talk will also highlight the advancements in cartilage and meniscus regeneration over past twenty years in Europe and discuss future directions for achieving more effective translation from the bench to the clinic.

PurposeAutologous chondrocyte implantation (ACI) is a complex procedure for cartilage defects, requiring patient understanding of treatment and recovery, as health literacy impacts outcomes. This study evaluated the quality and readability of AI‐generated ACI materials using ChatGPT‐4o as adjuncts to physician‐led education. We compared responses from the native model and a fine‐tuned version and hypothesised that the fine‐tuned model would provide improved quality and readability.MethodsTwenty‐two frequently asked questions were identified using Google's ‘People Also Asked’ feature. Two ChatGPT‐4o configurations were evaluated: the native model and a fine‐tuned version (ACI guide) optimised by instruction‐based fine‐tuning and reinforcement learning from human feedback. Two orthopaedic surgeons independently scored the responses. Quality was assessed using the DISCERN criteria and readability by the Flesch Reading Ease Score (FRES) and Flesch‐Kincaid Grade Level (FKGL). Interrater reliability was determined using intraclass correlation coefficient (ICC) in a two‐way mixed‐effects model.ResultsThe fine‐tuned ACI Guide outperformed the native ChatGPT‐4o on all parameters. The native model produced poor‐quality responses with a mean DISCERN score of 35.29 ± 5.0 (range: 23–45), while the ACI Guide achieved a significantly higher score of 43.18 ± 3.92 (range: 34–53; p < 0.001), reflecting moderate quality. Regarding readability, the native model reached FKGL of 13.45 ± 1.30 (university sophomore level). In contrast, the ACI Guide achieved FKGL of 9.25 ± 1.64 (9th‐grade level). The FRES was also significantly higher for the ACI Guide (49.59 ± 10.44) than the native model (35.68 ± 5.08; p < 0.001). Interrater reliability was strong (ICC = 0.767), indicating good agreement.ConclusionsChatGPT‐4o's responses were of poor quality and written at a readability level substantially exceeding recommended thresholds for patient education materials, limiting their applicability in clinical communication and patient education. Fine‐tuning ChatGPT‐4o improved the readability and quality of ACI patient education materials, generating content closer to the 8th–9th‐grade level. It may serve as a useful adjunct to physician‐led education in enhancing patient understanding of complex orthopaedic procedures.Level of EvidenceLevel V.

Fetal bovine serum (FBS) and human autologous serum are commonly used as supplements for chondrocyte culture in autologous chondrocyte implantation (ACI). However, FBS carries risks of pathogen contamination, ethical concerns, and inconsistent composition, while autologous serum is limited by availability and patient-specific factors that can impair chondrocyte quality. Platelet-derived products, such as our in-house developed lyophilized human platelet lysate (L-HPL) pooled from 16 donors [1], offer a promising, allogenic alternative. This study evaluated the potential of L-HPL to enhance chondrocyte quality for ACI. Human chondrocytes cultured with L-HPL were compared to those cultured with FBS in terms of in vitro multiplication, chondrogenicity and immunomodulatory potential.Cartilage tissue was harvested from section blocs during knee arthroplasty of six patients. Chondrocytes were cultured in medium containing 7% L-HPL or 10% FBS. Outcomes assessed included proliferation, viability, morphology, chondrogenic redifferentiation in 3D spheroids, and immunomodulatory potential. Chondrogenic capacity was analyzed via total protein content, proteoglycan content, and collagen II staining. Inflammatory mediator secretion was quantified before, during, and after IL-1β stimulation using multiplex immunoassays.Chondrocytes cultured with L-HPL showed significantly higher proliferation, viability, and cell numbers than FBS-cultured cells. High-content imaging revealed longer actin segments and reduced actin compactness in the L-HPL group. With and without chondrogenic stimulus with TGF-β1, spheroids derived from L-HPL-cultured chondrocytes exhibited greater protein and proteoglycan content, larger size, and higher collagen II expression. L-HPL-cultured cells secreted more anti-inflammatory IL-10 and significantly less pro-inflammatory IL-17A and IL-18 compared to FBS-cultured cells during and after IL-1β exposure. Using L-HPL as a culture supplement significantly enhances the quantity and quality of human chondrocytes, producing larger, more robust spheroids with improved cartilage-specific matrix expression. Additionally, L-HPL-derived chondrocytes exhibit an anti-inflammatory profile, potentially improving post-operative outcomes. These findings suggest that L-HPL could increase the success of ACI while reducing pre-therapeutic failures. Next steps include GMP-compliant L-HPL production for clinical translation of optimized ACI.

ObjectiveTo determine the association between socioeconomic deprivation and short-term patient-reported clinical outcomes following autologous chondrocyte implantation (ACI).DesignAll patients receiving knee ACI between 1996 and 2020 in our center were identified. Socioeconomic deprivation of their residential area was quantified using the Index of Multiple Deprivation (IMD). Patient-reported 1-year Lysholm and Intermittent and Constant Osteoarthritis Pain (ICOAP) scores were used as outcome measures in the analyses. After transformation to ensure normal distributions (where required), linear multivariable regression was used to analyze the relationship between IMD and 1-year Lysholm score, adjusting for demographic characteristics (age, sex, body mass index [BMI], and smoking) and baseline Lysholm.ResultsThree hundred and ninety-one patients with a mean age of 50 years (range = 16-84; 266 male) were identified. Median BMI was 27 (17-47), with 138 patients overweight and 105 obese. Seventy-seven patients lived in upper and 41 in lower quintile deprivation areas. The mean baseline Lysholm score was 49.8 ± 17.3 SD, improving to 66.5 ± 21.3 SD at 1 year. Mean 1-year Lysholm scores were significantly lower with increasing area deprivation scores, adjusted for demographic factors. Specifically, areas with high unemployment levels, being female, or having a lower baseline Lysholm were associated with poorer outcomes, but age, BMI, smoking, or higher income deprivation were not.ConclusionThis study demonstrates poorer functional outcomes following ACI in patients from more deprived areas, indicating future studies should consider neighborhood deprivation as a confounding factor. Furthermore, targeting patients from areas with higher deprivation with additional interventions/community support may improve their outcomes.