Purpose: This prospective study assessed the 10-year clinical outcomes of periosteum autologous chondrocyte implantation (ACI) due to cartilage lesions of the femoral condyles.
Methods: Thirty-three of 45 patients (3 failures, 7 non-responders, 2 others) were available for clinical and radiographic evaluation at 2, 5, and 10 years. Patients were categorized into groups with focal cartilage lesions, osteochondritis dissecans (OCD), and cartilage lesions with simultaneous ACL reconstruction (ACL). Seven patients in the overall series required an arthroscopic re-intervention (3 ACI related, 4 ACI unrelated).
Results: Subjective knee scores and activity scores were significantly improved at 2 years toward their pre-operative levels and then remained stable up to 10 years; however, patients did not reach their pre-injury activity levels. Upon 10-year examination, using the IKDC knee examination form, there were 15 normal, 11 nearly normal, 5 abnormal, and 2 severely abnormal knees. Radiographic evidence of osteoarthritis was found in 45% of patients (5 focal lesions, 2 OCD, and 8 ACL).
Conclusions: ACI provided safe and stable performance of operated knees over 10 years with a significant improvement toward pre-operative levels. Patients restrained from high-impact knee joint activities, post-surgery, and their knee radiographs demonstrated a high incidence of knee OA in trauma-related lesions. Optimal long-term performance is expected in localized, low-impact cartilage lesions of young patients.
Level of evidence: Case series, Level IV.