Abstract
Purpose To evaluate outcomes and magnetic resonance imaging (MRI) findings after use of particulated juvenile cartilage for the treatment of focal Outerbridge grade 4 articular cartilage defects of the patella. Methods From 2007 to 2011, 16 patients (2 bilateral) underwent a novel single-stage articular cartilage restoration procedure using particulated juvenile articular cartilage allograft. We enrolled 15 knees (13 patients) in this study. The mean age at surgery was 26.4 ± 9.1 years, and the mean postoperative follow-up was 28.8 ± 10.2 months. A musculoskeletal radiologist evaluated each knee with postoperative MRI for the International Cartilage Repair Society cartilage repair assessment score, graft hypertrophy, bony changes around the graft, and percent fill of the defect. All patients also completed the Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee Subjective Knee Evaluation, and Kujala clinical outcome survey (scale, 0 to 100), as well as the Tegner activity scale and visual analog pain scale (scale, 0 to 10). Results The mean International Cartilage Repair Society cartilage repair assessment score on MRI was 8.0 ± 2.8, a nearly normal assessment. Of 15 knees, 11 (73%) were found to have normal or nearly normal cartilage repair. Three patients had mild graft hypertrophy whereas 2 had gross graft hypertrophy, 2 of whom required arthroscopic debridement because of symptoms. The mean fill of the defect at follow-up was 89% ± 19.6%, with 12 of 15 knees (80%) showing at least 90% defect coverage. The mean clinical outcome score at follow-up was 73.3 ± 17.6 for the International Knee Documentation Committee evaluation, and the mean scores for each subdomain of the Knee Injury and Osteoarthritis Outcome Score were as follows: 84.2 ± 14.2 for pain, 85.0 ± 12.3 for symptoms and stiffness, 88.9 ± 12.9 for activities of daily living, 62.0 ± 25.1 for sports and recreation, and 60.8 ± 28.6 for quality of life. The median score for the Kujala survey was 79 (range, 55 to 99). The median score on the Tegner activity scale was 5 (range, 3 to 9), and the mean score on the visual analog scale was 1.9 ± 1.4, indicating minimal pain. Conclusions Preliminary results suggest that cartilage restoration using particulated juvenile articular cartilage allograft offers a viable option for patients with focal grade 4 articular cartilage defects of the patella. Level of Evidence Level IV, therapeutic case series.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1661-1670 |
| Number of pages | 10 |
| Journal | Arthroscopy - Journal of Arthroscopic and Related Surgery |
| Volume | 29 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 2013 |
Bibliographical note
Funding Information:The authors report the following potential conflict of interest or source of funding: Zimmer provided funding for the postoperative MRI evaluations. D.R.D. receives support from Zimmer provided grant funding to the institution to cover the cost of postoperative MRI. K.F.B. receives support from Zimmer Holdings. K.F.B. is a consultant for Zimmer and has been paid for speaking engagements as well as work done for the company. K.F.B. was also one of the developers of and received royalties for the cartilage technique that is the focus of this article. K.F.B. receives support from Zimmer on the topic of other cartilage procedures that are not the focus of this article. K.F.B. receives support from Zimmer related to other cartilage implants not related to the focus of this article.
Funding Information:
The authors thank Zimmer for funding the postoperative MRI evaluations. They also thank Carolyn Battaglia, C.C.R.C., and Jennifer Hart, P.A., for all of their assistance in data collection. Lastly, they thank Drs. Eric Carson and Joshua Nelson for helping to initiate the idea for this study.
Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.