Prospective Clinical and Radiologic Evaluation of Patellofemoral Matrix-Induced Autologous Chondrocyte Implantation

Ebert, Jay R.; Fallon, Michael B.; Smith, Anne; Janes, Gregory C.; Wood, David

doi:10.1177/0363546515574063

Cited by 47 publications

(60 citation statements)

References 48 publications

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“…In patients with focal III and IV degrees chondral defects, two studies have reported good clinical results after ACI 66,67. In both of these studies, a tibial tubercle transfer and lateral release was used to treat patients with patellofemoral malalignment 66,67.…”

Section: Therapymentioning

confidence: 99%

“…In both of these studies, a tibial tubercle transfer and lateral release was used to treat patients with patellofemoral malalignment 66,67. In a long-term follow-up study, ACI in combination with anteromedialization of the tibial tuberosity resulted in significant amelioration of symptoms and improvement in function with a low incidence of adverse events in patients with isolated, symptomatic, patellar chondral defects after a mean follow-up period of more than 7 years 68.…”

Section: Therapymentioning

confidence: 99%

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Patellofemoral pain in athletes

Petersen

Rembitzki

Liebau

2017

OAJSM

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Patellofemoral pain (PFP) is a frequent cause of anterior knee pain in athletes, which affects patients with and without structural patellofemoral joint (PFJ) damage. Most younger patients do not have any structural changes to the PFJ, such as an increased Q angle and a cartilage damage. This clinical entity is known as patellofemoral pain syndrome (PFPS). Older patients usually present with signs of patellofemoral osteoarthritis (PFOA). A key factor in PFPS development is dynamic valgus of the lower extremity, which leads to lateral patellar maltracking. Causes of dynamic valgus include weak hip muscles and rearfoot eversion with pes pronatus valgus. These factors can also be observed in patients with PFOA. The available evidence suggests that patients with PFP are best managed with a tailored, multimodal, nonoperative treatment program that includes short-term pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs), passive correction of patellar maltracking with medially directed tape or braces, correction of the dynamic valgus with exercise programs that target the muscles of the lower extremity, hip, and trunk, and the use of foot orthoses in patients with additional foot abnormalities.

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Section: Therapymentioning

confidence: 99%

Section: Therapymentioning

confidence: 99%

Patellofemoral pain in athletes

Petersen

Rembitzki

Liebau

2017

OAJSM

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“…The main indications for cartilage restoration are Outerbridge or International Cartilage Repair Society grade III or IV focal chondral or osteochondral defects of the loadbearing articular surface of the patellofemoral joint in patients with symptomatic knee pain in whom a sufficient trial of nonsurgical treatment has been unsuccessful. 1,3,4,6,7,10,12,15 General contraindications to cartilage restoration include osteoarthritis of the patellofemoral joint, inflammatory disease, medical contraindications, lower grade lesions, and patient inability to comply with postoperative rehabilitation protocols. 8 Additionally, outcomes may be better after management of unipolar lesions and contained lesions than after management of bipolar lesions and uncontained lesions.…”

Section: Indicationsmentioning

confidence: 99%

“…1,[7][8][9][10][11] Untreated chondral lesions may be a contributing factor in activity-limiting anterior knee pain. [4][5][6][7][8]10,[12][13][14] The main goal in managing patellar and trochlear chondral injuries is to restore cartilage surface congruity with sufficient biomechanical properties to alleviate symptoms, facilitate the return to previous level of activity, and improve quality of life. 5…”

mentioning

confidence: 99%

Cartilage Restoration Techniques for the Patellofemoral Joint

Brophy

Wojahn

Lamplot

2017

J Am Acad Orthop Surg

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Symptomatic osteochondral lesions of the patellofemoral joint are clinically challenging to manage because of the limited healing potential of articular cartilage; the complex morphology of the patellofemoral joint; the heterogeneity of the articular surface between patients; and high stresses across the joint, which can be altered by malalignment, tilt, or maltracking. Indications for surgery include traumatic lesions, osteochondritis dissecans, and high-grade chondromalacia in association with persistent pain despite a course of nonsurgical management. Various techniques have been described for managing symptomatic osteochondral lesions of the patellofemoral joint, including microfracture, osteochondral autograft transplantation, and biologic cell transplantation, including autologous chondrocyte implantation. Salvage techniques (eg, fresh allograft) may provide satisfactory outcomes after a failed attempt at surgical management. Irrespective of the surgical technique used, outcomes are generally worse in the patellofemoral compartment than in the tibiofemoral joint. The concomitant management of associated pathology, including patellar malalignment, is recommended because it has been shown to improve the success of cartilage restoration procedures.

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“…First generation of ACI used a porcine periosteal cover (ACI-P) which was replaced by a collagen type I/III cover in the second generation ACI-C both of which were secured with sutures; the collagen cover was proven to have lower instances of post-operative hypertrophy compared to periosteal covers [69,70]. Third generation of cell-based regenerative therapy for treatment of full-thickness cartilage defects is referred to as maxtrix-induced autoloug chondrocyte implantation (MACI) which adapted the second generation collage type I/III membrane into a bilayer membrane "seeded" with autologous chondrocytes and secured with fibrin glue [69][70][71][72][73][74]. MACI is a two-stage procedure including harvesting of chondrocytes for graft preparation then transplant/implantation of chondrocyte matrix graft approximately 4-6 weeks later.…”

Section: Autologous Chondrocyte Implantationmentioning

confidence: 99%