Date of Presentation
5-4-2023 12:00 AM
College
School of Osteopathic Medicine
Poster Abstract
Abstract Background: Articular cartilage pathology can stem from a spectrum of etiologies including osteochondritis dissecans, avascular necrosis, degenerative joint disease, and injury resulting from recurrent instability of the patella.
Hypothesis/Purpose: The purpose of this study was to identify differences in clinical and functional outcomes in patients treated with either ACI or OCA transplantation for chondral defects with concomitant MPFL reconstruction and tibia tubercle osteotomy.
Study Design: Retrospective Cohort Study
Methods: A retrospective review identified patients who underwent autologous chondrocyte implantation (ACI) or osteochondral allograft (OCA) transplantation with concomitant medial patellofemoral ligament (MPFL) reconstruction and tibia tubercle osteotomy (TTO). Outcome measures included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), International Knee Documentation Committee (IKDC) evaluation, and Short Form Health Survey (SF-12) physical scores, all collected a minimum of 2 years after surgery. Defect location, size, complications, and rate of subsequent surgery were determined.
Results: Eighteen patients (11 ACI and 7 OCA) were included in this study to analyze clinical and functional outcomes following surgical correction of 23 chondral defects (ACI n=12, OCA n=10). Defects had comparable baseline characteristics in each group including size measured during index arthroscopy (3.34 cm2 vs 4.03 cm2, P = .351), Outerbridge classification (54.8% grade 4 vs 60.0% grade 4, P = 1.000), and AMADEUS score (47.1 vs 58.6, P = .298). Postoperative outcomes were comparable including revision rate (15.4% vs 10.0%, P=1.000) and 2-year IKDC scores (74.2 vs 51.2, P = .077). However, ACI did have significantly higher 2-year KOOS JR (85.1 vs 63.7, P = .031) and SF-12 scores (54.1 vs 42.6, P = .007) compared to OCA.
Conclusion: ACI or OCA transplantation for chondral defects with concomitant MPFL reconstruction and TTO can be safely performed in an outpatient setting with functional and clinical outcomes being comparable. Functional scores including KOOS JR and SF-12 were shown to be significantly higher at 2-year follow-up in the ACI cohort, however, postoperative IKDC scores, rates of revisions, and clinical evaluations were comparable between cohorts.
Keywords
Allografts, Transplants, Patella, Subchondral Arthroplasty, Treatment Outcome
Disciplines
Health and Medical Administration | Medicine and Health Sciences | Musculoskeletal Diseases | Orthopedics | Surgery
Document Type
Poster
Included in
Health and Medical Administration Commons, Musculoskeletal Diseases Commons, Orthopedics Commons, Surgery Commons
Comparative Outcomes of Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation with Patellar Realignment for Patellar Instability with Associated Cartilage Defects
Abstract Background: Articular cartilage pathology can stem from a spectrum of etiologies including osteochondritis dissecans, avascular necrosis, degenerative joint disease, and injury resulting from recurrent instability of the patella.
Hypothesis/Purpose: The purpose of this study was to identify differences in clinical and functional outcomes in patients treated with either ACI or OCA transplantation for chondral defects with concomitant MPFL reconstruction and tibia tubercle osteotomy.
Study Design: Retrospective Cohort Study
Methods: A retrospective review identified patients who underwent autologous chondrocyte implantation (ACI) or osteochondral allograft (OCA) transplantation with concomitant medial patellofemoral ligament (MPFL) reconstruction and tibia tubercle osteotomy (TTO). Outcome measures included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), International Knee Documentation Committee (IKDC) evaluation, and Short Form Health Survey (SF-12) physical scores, all collected a minimum of 2 years after surgery. Defect location, size, complications, and rate of subsequent surgery were determined.
Results: Eighteen patients (11 ACI and 7 OCA) were included in this study to analyze clinical and functional outcomes following surgical correction of 23 chondral defects (ACI n=12, OCA n=10). Defects had comparable baseline characteristics in each group including size measured during index arthroscopy (3.34 cm2 vs 4.03 cm2, P = .351), Outerbridge classification (54.8% grade 4 vs 60.0% grade 4, P = 1.000), and AMADEUS score (47.1 vs 58.6, P = .298). Postoperative outcomes were comparable including revision rate (15.4% vs 10.0%, P=1.000) and 2-year IKDC scores (74.2 vs 51.2, P = .077). However, ACI did have significantly higher 2-year KOOS JR (85.1 vs 63.7, P = .031) and SF-12 scores (54.1 vs 42.6, P = .007) compared to OCA.
Conclusion: ACI or OCA transplantation for chondral defects with concomitant MPFL reconstruction and TTO can be safely performed in an outpatient setting with functional and clinical outcomes being comparable. Functional scores including KOOS JR and SF-12 were shown to be significantly higher at 2-year follow-up in the ACI cohort, however, postoperative IKDC scores, rates of revisions, and clinical evaluations were comparable between cohorts.