Clinical and Radiological Outcomes at ≥10-Year Follow-up After Matrix-induced Autologous Chondrocyte Implantation in the Patellofemoral Joint.

Autor:	Ebert JR; School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Western Australia, Australia.; HFRC Rehabilitation Clinic, Nedlands, Western Australia, Australia., Klinken S; Perth Radiological Clinic, Subiaco, Western Australia, Australia., Fallon M; Perth Radiological Clinic, Subiaco, Western Australia, Australia., Wood DJ; Medical School, University of Western Australia, Crawley, Western Australia, Australia., Janes GC; Perth Orthopaedic & Sports Medicine Centre, West Perth, Western Australia, Australia.
Jazyk:	angličtina
Zdroj:	The American journal of sports medicine [Am J Sports Med] 2024 Aug; Vol. 52 (10), pp. 2532-2540. Date of Electronic Publication: 2024 Aug 05.
DOI:	10.1177/03635465241262337
Abstrakt:	Background: Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging outcomes in the treatment of knee cartilage defects, although limited research is available on its longer term (≥10 years) sustainability in the patellofemoral joint. Purpose: To report the clinical and radiological outcomes at ≥10 years in a prospectively recruited cohort of patients undergoing MACI in the patellofemoral joint and compare outcomes in patients undergoing MACI on the patella versus the trochlea. Study Design: Case series; Level of evidence, 4. Methods: The current study prospectively enrolled 95 patients who underwent patellofemoral MACI, of whom 29 (13 patella, 16 trochlea) underwent concomitant tibial tubercle osteotomy. Patients were assessed preoperatively and at 2, 5, and ≥10 years using a range of patient-reported outcome measures (PROMs) including the Knee injury and Osteoarthritis Outcome Score, the 36-item Short Form Health Survey, and the frequency and severity of knee pain as well as patient satisfaction, full active knee flexion and extension, and peak isokinetic knee extensor and flexor torques. High-resolution magnetic resonance imaging (MRI) was performed to assess pertinent graft parameters, as well as determine an overall MRI composite score, per the Magnetic Resonance Observation of Cartilage Repair Tissue scoring system. Results were analyzed according to the graft location (patella or trochlea). Results: Of the 95 patients recruited, 82 patients (41 patella, 41 trochlea) were available for a clinical review at ≥10 years after surgery (mean follow-up, 11.9 years [range, 10-15 years]). For the whole patellofemoral MACI cohort, all PROMs significantly improved over time ( P < .05), with no significant changes ( P > .05) observed in any MRI-based score from 2 to ≥10 years after surgery. At ≥10 years, 90.2% (n = 74) were satisfied with MACI in relieving their knee pain, and 85.4% (n = 70) were satisfied with the improvement in their ability to participate in sports. No differences ( P > .05) were observed in PROMs between those undergoing patellar MACI and those undergoing trochlear MACI, although a significant group effect was observed for limb symmetry indices of knee extensor ( P = .009) and flexor ( P = .041) strength, which were greater in those undergoing patellar (vs trochlear) MACI. No statistically significant differences ( P > .05) were observed between patellar and trochlear grafts on any MRI-based measure. In the cohort assessed at ≥10 years after surgery, 4 patients (2 patella, 2 trochlea) demonstrated graft failure on MRI scans, although a further 3 patients (all trochlea) were omitted from the ≥10-year review for having already progressed to total knee arthroplasty. Conclusion: Good clinical scores, high levels of patient satisfaction, and adequate graft survivorship were observed at ≥10 years after MACI on the patella and trochlea. Competing Interests: Presented as a poster at the annual meeting of the AOSSM, Denver, Colorado, July 2024.One or more of the authors has declared the following potential conflict of interest or source of funding: This research has received funding from the National Health and Medical Research Council (ID254622 and ID1003452) and an independent research grant from Vericel that assisted with later-stage follow-up of patients. G.C.J. owns shares in Orthocell. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Databáze:	MEDLINE
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