ACI, anteromedialization of isolated patella lesions show improved results at 5 years

Issue: July 2012

MONTREAL — According to results of a recently presented study, autologous chondrocyte implantation performed with anteromedialization of isolated patella articular cartilage lesions can lead to high patient satisfaction and significant improvements in symptoms and function.

Perspective from John P. Fulkerson, MD

Ryan M. Arnold, MD, presented the findings at the International Cartilage Repair Society World Congress 2012.

“The combination of [autologous chondrocyte implantation] ACI and [anteromedialization] AMZ in our study showed good mid-term results,” he said. “Statistically significant improvements in outcome measures do substantiate the results of previous studies at shorter intervals.”

The investigators studied 23 patients (25 knees) with isolated patella full-thickness articular cartilage defects and patellofemoral alignment who failed primary treatment and underwent ACI. The ACI procedures featured anteromedialization of the tibia tubercle and the use of a periosteal patch. Patients included in the study had a minimum 5-year follow-up.

With a mean follow-up of 91 months, Arnold reported that 83% of patients rated their outcomes as good or excellent. The investigators also found that the mean IKDC score improved from 43 to 76, the Lysholm score increased from 40 to 79 and modified Cincinnati increased from 3 to 7. Arnold noted that eight knees (33%) eventually underwent reoperation for periosteal patch hypertrophy. A single knee is scheduled for reoperation and patellofemoral arthroplasty at 67 months postoperatively.

“We know that ACI has been effective and optimal for the treatment of chondral lesions,” Arnold said. “It produces hyaline-like tissues and displays improved efficacy compared to other treatment options. AMZ does decrease the contact forces across the patellofemoral joint, particularly for lateral and inferior lesions.”

He added, “AMZ without an ACI has been shown to be poor for particular lesions, particularly medial and diffuse lesions. The treatment of chondral defects of the patella with ACI displays improved results when the pathomechanics of the patellofemoral joint are also addressed.” – by Robert Press

Reference:

Arnold RM, Gillogly SD. Autologous chondrocyte implantation and anteromedialization of isolated patella articular cartilage lesions: 5- to 12-year follow-up. Paper 25.2.4. Presented at the International Cartilage Repair Society World Congress 2012. May 12-15. Montreal.

For more information:

Ryan M. Arnold, MD, can be reached at OrthoWest, 2725 S. 144th St., Suite 212, Omaha, NE 68144; email: ryanarnoldmd@yahoo.com.

Disclosure:

Arnold has no relevant financial disclosures. His co-author has consulting agreements with Genzyme and has received research-based support.

Perspective

John P. Fulkerson, MD

The findings of these authors are consistent with my experience using anteromedial tibial tubercle transfer (AMZ) for patella articular disease. AMZ alone has been effective without autologous chondrocyte implantation (ACI) for painful lateral and distal patellar lesions. ACI, in addition to AMZ when appropriate, is a powerful combination, particularly as the authors state for those lesions that did less well with AMZ alone (Pidoriano and colleagues).

This study also re-emphasizes the importance and efficacy of patellofemoral joint preservation vs. replacement in younger patients.

John P. Fulkerson, MD

Orthopedic Associates of Hartford P.C.

Farmington, Conn.

Disclosures: Fulkerson has no relevant financial disclosures.