Date: 05 Apr 2012
Cell-based Therapy Improves Function in Adolescents and Young Adults With Patellar Osteochondritis Dissecans
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Recent advances have been made in using chondrocytes and other cell-based therapy to treat cartilage defects in adults. However, it is unclear whether these advances should be extended to the adolescent and young adult-aged patients.
We assessed cell-based surgical therapy for patellar osteochondritis dissecans (OCD) in adolescents and young adults by (1) determining function with the International Knee Documentation Committee (IKDC) subjective and Lysholm-Gillquist scores; and (2) evaluating activity level using the Tegner-Lysholm scale.
We retrospectively reviewed 23 patients between 12 and 21 years of age (mean 16.8 years) treated for OCD lesions involving the patella from 2001 to 2008. Twenty patients had autologous chondrocyte implantation and three patients had cultured bone marrow stem cell implantation. There were 19 males and four females. We obtained preoperative CT scans to assess patella subluxation, tilt, and congruence angle to determine choice of treatment. We obtained IKDC subjective knee evaluation scores, Tegner-Lysholm activity levels, and Lysholm-Gillquist knee scores preoperatively and at 6, 12, and 24 months postoperatively.
Mean IKDC score, Tegner-Lysholm outcomes, and Lysholm-Gillquist scale improved from 45, 2.5, and 50, respectively, at surgery to 75, 4, and 70, respectively, at 24-month followup. Complications include periosteal hypertrophy observed in two patients.
Cell-based therapy was associated with short-term improvement in function in adolescents and young adults with patellar OCD.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
Aichroth P. Osteochondritis dissecans of the knee. A clinical survey. J Bone Joint Surg Br. 1971;53:440–447.PubMed
Bradley J, Dandy DJ. Osteochondritis dissecans and other lesions of the femoral condyles. J Bone Joint Surg Br. 1989;71:518–522.PubMed
Clanton TO, DeLee JC. Osteochondritis dissecans. History, pathophysiology and current treatment concepts. Clin Orthop Relat Res. 1982;167:50–64.PubMed
Desai SS, Patel MR, Michelli LJ, Silver JW, Lidge RT. Osteochondritis dissecans of the patella. J Bone Joint Surg Br. 1987;69:320–325.PubMed
Dhollander AA, De Neve F, Almgvist KF, Verdonk R, Lambrecht S, Elewaut D, Verbruggen G, Verdonk PC. Autologous matrix-induced chondrogenesis combined with platelet-rich plasma gel: technical description and a five pilot patients report. Knee Surg Sports Traumatol Arthrosc. 2011;19:536–542.PubMedCrossRef
Farr J. Autologous chondrocyte implantation improves patellofemoral cartilage treatment outcomes. Clin Orthop Relat Res. 2007;463:187–194.PubMed
Fu FH, Zurakowski D, Browne JE, Mandelbaum B, Erggelet C, Moseley JB Jr, Anderson AF, Micheli LJ. Autologous chondrocyte implantation versus debridement for treatment of full-thickness chondral defects of the knee: an observational cohort study with 3-year follow-up. Am J Sports Med. 2005;33:1658–1666.PubMedCrossRef
Mandelbaum BR, Browne JE, Fu F, Micheli L, Mosely JB Jr, Erggelet C, Minas T, Peterson L. Articular cartilage lesions of the knee. Am J Sports Med. 1998;26:853–861.PubMed
Peters TA, McLean ID. Osteochondritis dissecans of the patellofemoral joint. Am J Sports Med. 2000;28:63–67.PubMed
Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A. Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med. 2002;30:2–12.PubMed
Pridie K. A method of resurfacing knee joints. J Bone Joint Surg Br. 1959;41:618–619.
Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–49.PubMed
Wakitani S, Goto T, Pineda SJ, Young RG, Mansour JM, Caplan AI, Goldberg VM. Mesenchymal cell-based repair of large, full-thickness defects of articular cartilage. J Bone Joint Surg Am. 1994;76:579–592.PubMed
Wakitani S, Nawata M, Tensho K, Okabe T, Machida H, Ohgushi H. Repair of articular cartilage defects in the patello-femoral joint with autologous bone marrow mesenchymal cell transplantation: three case reports involving nine defects in five knees. J Tissue Eng Regen Med. 2007;1:74–79.PubMedCrossRef
- Cell-based Therapy Improves Function in Adolescents and Young Adults With Patellar Osteochondritis Dissecans
Clinical Orthopaedics and Related Research®
Volume 471, Issue 4 , pp 1152-1158
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- 2. Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
- 3. Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- 4. Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore