Particulated juvenile allograft yielded good outcomes in patellofemoral cartilage defects
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Published results showed particulated juvenile allograft cartilage implantation for patellofemoral chondral defects may yield satisfactory short-term outcomes and postoperative MRI appearance in pediatric and adolescent patients.
Daniel W. Green, MD, MS, FAAP, FACS, and colleagues performed a retrospective review of findings for 36 knees in 34 patients with full-thickness cartilaginous defects of the patellofemoral joint treated with Denovo NT particulated juvenile allograft cartilage (Zimmer Inc.) between 2012 and 2019. To be included in the study, patients had to be 21 years of age or younger with minimum clinical follow-up of 1-year and postoperative MRI at a minimum of 6 months, according to researchers. Researchers independently assessed cartilage restoration by MRI with the International Cartilage Repair Society standardized system.
Results showed 25 cases had defects on the patella, nine cases had defects on the lateral femoral trochlea and two cases had defects on the medial femoral trochlea. Of the 25 patients who reported involvement in one or more organized athletic activity before surgery, researchers found 100% returned to sport postoperatively at the same or higher level than prior to their injury and 96% of patients returned to sport without pain. Independent MRI assessment showed two-thirds of defects achieved an overall grade of normal or nearly normal. Researchers noted 78% of patients had graft filling at 50% or greater of the lesion depth, 56% of patients had graft filling at 75% or greater of the lesion depth and 31% of patients had graft filling at 100% of the lesion depth. Two cases experienced primary graft failure, and one patient experienced a surgical complication, according to results.
Subgroup analysis showed significantly higher ICRS assessment scores and significantly higher rates of 75% or better defect fill among patients with open or partially open distal femoral physes. Researchers also found significantly higher ICRS assessment scores, significantly higher rates of normal ICRS grades and significantly higher rates of 75% or better defect fill among patients with an underlying pathology of juvenile osteochondritis dissecans.
“With an average follow-up of 2.5 years, this study demonstrated that restoration of patellofemoral chondral defects in these young patients with particulated juvenile allograft results in satisfactory short-term outcomes and postoperative MRI appearance, along with high rates of return to sport and low rate of complications and graft failure,” Green, a pediatric orthopedic surgeon at Hospital for Special Surgery, told Healio Orthopedics. “This series of patients appears to be the largest single cohort of pediatric and adolescent patients who received particulated juvenile allograft cartilage for defects of the patellofemoral joint.”
Perspective
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The treatment of chondral lesions of the patellofemoral joint has been challenging due to variable cartilage thickness, unique contour of the joint and anatomic risk factors, which influence the dynamic relationship of the articulation, causing high compression and shear forces.
The authors report satisfactory short-term clinical and MRI-based outcomes of such lesions using the novel cell-based technique of particulated juvenile allograft cartilage in 34 adolescent patients with a mean age of 16.1 years. All patients were able to return to sports. Complications were few; one patient had joint infection and two had graft failures, but none had graft hypertrophy.
The advantage of particulated juvenile allograft cartilage includes single-stage application, technical ease, no donor site morbidity and higher regenerative potential of juvenile chondrocytes. Limitations of this study include a lack of a comparison group and concurrent procedures, which makes it difficult to attribute these results to particulated juvenile allograft cartilage alone. Also, a cartilage-sensitive T2-mapping MRI sequence could provide qualitative assessment of cartilage besides the defect fill and appearance. Overall, particulated juvenile allograft cartilage should be included in the surgical armamentarium of patellofemoral surgeons.
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