KS28: PERIOSTEAL ACI: A MINIMUM FIVE YEAR FOLLOW UP STUDY

Abstract

Introduction & Aims: To assess the efficacy of periosteal ACI (P-ACI) for articular cartilage lesions of the knee, a study was carried out on patients with minimum 5 year follow up including clinical assessment, second look arthroscopy when indicated clinically and MRI evaluation

Method: Between October 2000 and April 2003 the author carried out P-ACI on 164 patients. Of these 104 patients (106 knees – 145 lesions) could be included in this study.

There were 106 single, 35 double and three triple lesions. Seventy-eight lesions were considered traumatic, 63 degenerative and 4 OCD.

Previous surgery was frequent. Arthroscopic debridement (78), meniscal surgery (52), arthroscopic micro-fracture (19), ACL (12), lateral release (6), UTO (4) and extensor realignment (2).

Results: Results were assessed according to the ICRS cartilage repair evaluation package.

Significant improvement was seen in average Activity Level, Objective Knee Examination, Physical Component Score and Mental Component Score. IKDC subjective assessment improved by an average of 21 points.

There were 6 failures, 5 coming to TKR in the course of this study and 1 with advanced degenerative change requiring TKR.

“Second look” arthroscopy was carried out on 75 knees with 102 lesions at average 26 months from implantation for graft hypertrophy/extrusion presenting as painless mechanical symptoms (24), partial or complete periosteal patch loss (8), partial loss of graft (9), adjacent loss of host cartilage (4) and total loss of graft (3).

“Third look” arthroscopy occurred in 35 knees with 35 lesions at average 44.4 months from index implantation for partial loss of graft (8), adjacent host cartilage lesion (8), hypertrophy or periosteal patch detachment (6), new remote cartilage lesion (4) and total loss of graft (2).

“Fourth look” arthroscopy was carried out on 9 knees with 12 lesions at average 59 months from index implantation for adjacent host cartilage loss (4), partial loss of graft (3) and advancing degenerative change (3).

Conclusion: This study supports the efficacy of P-ACI for appropriate articular cartilage lesions of the knee with good clinical outcome and satisfactory repair when assessed arthroscopically Subsequent arthroscopic surgery was frequently required, predominantly related to the periosteal patch in the first year, after which adjacent host cartilage lesions, remote new cartilage lesions and partial loss of the graft became more Significant.