Abstract
Introduction
The purpose of this study is to evaluate the early functional outcome and activity level in athletes and soldiers with large full thickness cartilage defects of the knee that underwent either ‘classic’ autologous chondrocyte implantation using periosteal flap coverage (ACI-P) or 3-D matrix-assisted chondrocyte implantation (ACI-M).
Methods
Between April 2002 and January 2004, 19 patients (15 male, 4 female, average age 32.2 years) with 22 full-thickness cartilage defects in 19 knees were treated with ACI in our centre. The mean post-injury interval was 39.8 months whereas 17 (89.5%) patients had undergone at least one surgical procedure before ACI. The average defect size was 6.54 cm2 (located in MFC:7, LFC:7 or trochlear:2 while 3 patients had bifocal lesions in both LFC and TRC). Novocart¯ cultured chondrocytes with periosteal flap coverage were used in 11 patients and Novocart-3D¯ cell impregnated collagen patch in 8. The functional outcome was evaluated with IKDC form, Tegner activity scale and Lysholm score after a mean follow-up period of 26.5 months.
Results
The average IKDC and Lysholm scores were improved from 39.16 and 42.42 pre-operatively to 62.4 and 69.4 at the latest follow-up respectively. The mean Tegner activity scale was 8.73 before injury, 3.63 pre-operatively and 5.21 at the latest follow-up. There was no statistically significant difference between the two groups regarding the clinical outcome and the overall athletic or military performance. Second-look arthroscopy was performed in 11 (57.8%) patients due to persistent pain and/or mechanical symptoms. Generally, the ACI site showed adequate graft integration except for one partial failure.
Conclusions
The early results of ACI in high-performance athletes and professional soldiers are not as good as other recent studies suggest. Motivational issues during prolonged rehabilitation, patient age and very large defects may influence early results in this select group of patients.
