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First published on July 10, 2006, doi:10.1177/0363546506288853
This version was published on November 1, 2006
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Right arrow Chondral/cartilage
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The American Journal of Sports Medicine 34:1763-1773 (2006)
© 2006 American Orthopaedic Society for Sports Medicine

Patellofemoral Full-Thickness Chondral Defects Treated With Hyalograft-C

A Clinical, Arthroscopic, and Histologic Review

Alberto Gobbi, MD*,{dagger}, Elisaveta Kon, MD{ddagger}, Massimo Berruto, MD§, Ramces Francisco, MD{dagger}, Giuseppe Filardo, MD{ddagger} and Maurilio Marcacci, MD{ddagger}

From the {dagger} Orthopaedic Arthroscopic Surgery International, Milan, Italy, {ddagger} Istituto Ortopedico Rizzoli, Bologna, Italy, and § Istituto Ortopedico Gaetano Pini, Milan, Italy

* Address correspondence to Alberto Gobbi, MD, 24 Via Amadeo, Milan, Italy 20133 (e-mail: sportmd{at}tin.it).

Background: Tissue engineering has emerged as a potential therapeutic option for cartilage regeneration.

Hypothesis: Hyaluronan-based scaffolds seeded with autologous chondrocytes are a viable treatment for damaged articular surface of the patellofemoral joint.

Study Design: Case series; Level of evidence, 4.

Methods: Thirty-two chondral lesions with a mean size of 4.7 cm2 were treated with Hyalograft-C. Twenty-two lesions were located in the patella and 10 in the trochlea. Sixteen patients had previous trauma, 3 had osteochondritis dissecans, and 13 had degenerative changes. Transplantations were carried out arthroscopically or through a miniarthrotomy incision. Eight patients had concomitant procedures, including patellar realignment (2), lateral release (3), and meniscectomy (3). Results were evaluated using the International Cartilage Repair Society–International Knee Documentation Committee scale, EuroQol EQ-5D form, and magnetic resonance imaging scans at 12 and 24 months. Six patients had second-look arthroscopy and biopsies. Statistical analysis was performed using the paired t test and Wilcoxon signed rank test.

Results: The International Cartilage Repair Society–International Knee Documentation Committee and EuroQol EQ-5D scores demonstrated a statistically significant improvement (P < .0001). Objective preoperative data improved from 6/32 (18.8%) with International Knee Documentation Committee A or B to 29/32 (90.7%) at 24 months after transplantation. Mean subjective scores improved from 43.2 points preoperatively to 73.6 points 24 months after implantation. Magnetic resonance imaging studies at 24 months revealed 71% to have an almost normal cartilage with positive correlation to clinical outcomes. Second-look arthroscopies in 6 cases revealed the repaired surface to be nearly normal with biopsy samples characterized as hyaline-like in appearance.

Conclusion: Biodegradable scaffolds seeded with autologous chondrocytes can be a viable treatment for chondral lesions. The type of tissue repair achieved demonstrated histologic characteristics similar to normal articular cartilage. Long-term investigations are needed to determine the durability of the repair produced with this technique.

Key Words: autologous chondrocyte implantation (ACI) • chondral lesions • patellofemoral • chondrocytes • scaffold




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