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Five years after chondrocyte implantation for patellofemoral pain

PainSci » bibliography » Gobbi et al 2009
Tags: patellar pain, arthritis, surgery, treatment, knee, aging, pain problems, leg, limbs, overuse injury, injury, running, exercise, self-treatment

One article on PainSci cites Gobbi 2009: Does Cartilage Regeneration Work?

PainSci commentary on Gobbi 2009: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Chondrocyte implantation is a new surgical technique for osteoarthritis. This paper describes 34 cases five years after the surgery. Although improved, most patients were far from “cured.” Earlier in 2009, Kon found similar results, and in particular found chondrocyte implantation to be superior to microfracture repair technique.

These patients may have done well, or possibly even better, without the procedure. Always bear in mind that the value of uncontrolled studies of knee surgeries should be suspect in principle, but especially since the surprising discovery (see Moseley) that a surgical placebo can act very strongly on patients.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Patellofemoral lesions represent a very troublesome condition to treat for orthopaedic surgeons; however, second-generation autologous chondrocyte implantation (ACI) seems to offer an interesting treatment option with satisfactory results at short-term follow-up. Hypothesis :Hyaluronan-based scaffold seeded with autologous chondrocytes is a viable treatment for the damaged articular surface of the patellofemoral joint.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Among a group of 38 patients treated for full-thickness patellofemoral chondral lesions with second-generation ACI, we investigated 34 who were available for final follow-up at 5 years. These 34 had chondral lesions with a mean size of 4.45 cm2. Twenty-one lesions were located on the patella, 9 on the trochlea, and 4 patients had multiple lesions: 3 had patellar and trochlear lesions, and 1 had patellar and lateral femoral condyle lesions. Twenty-six lesions (76.47%) were classified as International Cartilage Repair Society (ICRS) grade IV A or B, 5 lesions (14.70%) were grade IIIC, and 3 (8.82%) were lesions secondary to osteochondritis dissecans (OCD). Results were evaluated using the International Knee Documentation Committee (IKDC) 2000 subjective and objective scores, EuroQol (EQ) visual analog scale (VAS), and Tegner scores at 2 and 5 years. Eight patients had second-look arthroscopy and biopsies.

RESULTS: All the scores used demonstrated a statistically significant improvement (P < .0005) at 2 and 5 years’ follow-up. Objective preoperative data improved from 8 of 34 (23.52%) normal or nearly normal knees to 32 of 34 (94.12%) at 2 years and 31 of 34 (91.17%) at 5 years after transplantation. Mean subjective scores improved from 46.09 points preoperatively to 77.06 points 2 years after implantation and 70.39 at 5 years. The Tegner score improved from 2.56 to 4.94 and 4.68, and the EQ VAS improved from 56.76 to 81.47 and 78.23 at 2 and 5 years’ follow-up, respectively. A significant decline of IKDC subjective and Tegner scores was found in patients with multiple and patellar lesions from 2 to 5 years’ follow-up. Second-look arthroscopies in 8 cases revealed the repaired surface to be nearly normal with biopsy samples characterized as hyaline-like in appearance.

CONCLUSION: Hyaluronan-based scaffold seeded with autologous chondrocytes can be a viable treatment for patellofemoral chondral lesions.

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