Cell-based therapy improves function in adolescents and young adults with patellar osteochondritis dissecans

Abstract

Background: 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.

Questions/purposes: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Fig. 1

On average, IKDC scores increased by 1.27 (95% CI, 0.87–1.66; p < 0.001) for every subsequent month of visit. Similarly, the average increase in Tegner-Lysholm and Lysholm-Gillquist scores were 0.07 (95% CI, 0.04–0.10) and 0.94 (95% CI, 0.56–1.32), respectively. The plots for IKDC, Tegner-Lysholm, and Lysholm-Gillquist scores are marked black, blue, and red, respectively.

Fig. 2A–B

MRI scans of Case 16 (A) at surgery and (B) at 4 months postoperatively showing hypertrophy of periosteum.