The aim of this study was to evaluate the efficacy of Hyalograft®-C, in a group of patients with full thickness patellofemoral defects.

Method: 32 patients treated with Hyalograft®-C for patellofemoral chondral lesions were evaluated. Average age was 30.5 yrs. with a mean follow-up period of 24 months. The defect area was 4.7 cm2 and the lesions were due to trauma (12 patients), malalignment (4) and osteochondritis dissecans (2). Eight patients had previous knee arthroscopy, 2 had patellar re-alignment, and 1 patient had lateral retinacular release. Subjective evaluation, ICRS-IKDC 2000 scores were used for final evaluation. Patients underwent MRI at 12 months, two patients had 2nd-look arthroscopy and biopsy. Student- T Test was used for statistical analysis.

Results: Significant improvement (p< 0.0001) with VAS scale and subjective evaluation using the ICRS scale was demonstrated. A statistically significant improvement was reported with IKDC scoring systems. MRI demonstrated almost normal cartilage in 70% of the cases with positive correlation to clinical outcomes. 2nd-look arthroscopies demonstrated good integration with the surrounding cartilage and biopsies were characterized as hyaline-like cartilage.

Conclusions: Hyalograft C is a viable option for treatment of patellofemoral cartilage lesions. Additional follow-up assessments will confirm the long-term durability of these results.

Introduction and Aims: To determine the efficacy of autologous chondrocyte implantation (ACI) in treating focal chondral defects of the knee, we reviewed the two-year treatment outcome of ACI in 53 patients through clinical evaluation, MRI, second-look arthroscopy and core biopsies obtained.

Method: From November 2000 to December 2003, 54 consecutive knees with 72 focal chondral defects (grade III or IV by modified Outerbridge) were treated with ACI using the Peterson periosteal patch technique. In this method, an initial arthroscopy was carried out to confirm the suitability for repair and when appropriate, cells were harvested either from the margins of the lesion, the intercondylar notch or both. The harvested cells were proliferated in vitro. Three to four weeks later, the cells were implanted in the defect with a medial or lateral parapatellar arthrotomy approach. A standardised post-operative rehabilitation protocol was carried out depending on the site of the lesion or lesions.

Results: Improvement in mean subjective score from pre-operative (37.6) to 12 months (56.4) and 24 (60.1) months post-ACI were observed. Knee function levels also improved (86% ICRS III/IV to 66.6% I/II) from pre-operative period to 24 months post-implantation. Objective IKDC score of A or B were observed in 88% pre-operatively. This decreased to 67.9% at three months before improving to 92.5% at 12 months and 94.4% at 24 months post-implantation. Transient deterioration in all these clinical scores was observed at three months before progressive improvement became evident. MRI studies demonstrated 75.3% with at least 50% defect fill, 46.3% with near normal signal, 68.1% with mild/no effusion and also 66.7% with mild/no underlying bone marrow edema at three months. These values improved to 94.2%, 86.9%, 91.3% and 88.4% respectively at 12 months. At 24 months, further improvement to 97%, 97%, 95.6% and 92.6% respectively were observed. Second-look arthroscopy carried out in 22 knees (32 lesions) demonstrated all grafts to be normal / nearly normal based on the International Cartilage Repair Society (ICRS) visual repair assessment while core biopsies from 20 lesions demonstrated 13 (65%) grafts to have hyaline / hyaline-like tissue.

Conclusion: Improvement in clinical and MRI findings obtained from second-look arthroscopy and core biopsies evaluated indicate that, at 24 months post-ACI, the resurfaced focal chondral defects of the knee remained intact and continued to function well.

Introduction Talar dome lesions are a common accompaniment of ankle injury resulting in ongoing symptoms and functional disability with current management resulting in fibrocartilaginous repair and failure to reconstitute the articular surface. In this study, the application of autologous chondrocyte implantation (ACI) for talar dome lesions was evaluated.

Methods Between August 2001 and February 2003, eight patients with osteochondral lesions of the talus were treated with ACI. All patients underwent initial arthroscopy to harvest healthy chondrocytes for cultivation. Cells were re-implanted after three to four weeks, with a medial or lateral malleolar osteotomy using a periosteal patch harvested from the distal tibia. Post-operatively, early ankle motion was allowed but non-weight bearing advised until union of osteotomy. Clinical assessment was pre-operatively and at three, six, nine, and 12 months post-operatively. Second-look arthroscopy with biopsy for histological examination was performed at removal of internal fixation. Four males and four females with a mean age of 40 years (range 22 to 59) are presented. Pre and postoperative clinical evaluation was done using the American Orthopaedic Foot and Ankle Society Hindfoot Score.

Results The mean pre-operative score was 58.4 (range 26 to 97); at three months, it was 62 (range 32 to 84); at six months 70.6 (range 66 to 92); at nine months 79 (range 66 to 92) and at 12 months 81.5 (range 79 to 84). MRI done in four patients at three months post-ACI showed good fill in three and slight over fill in one. Minimal subchondral edema was evident in one patient. Two patients with MRI 12 months post-ACI also revealed good fill with residual bone marrow oedema. Second-look arthroscopy and biopsy at implant removal in five patients were done at a mean of six months (range 2.5 to 9) post-ACI. Arthroscopy showed the transplants were level with the surrounding tissue. Four patients had biopsies showing hyaline-like cartilage which has all the properties of normal hyaline except for the increased cell density while one biopsy revealed fibro-hyaline tissue. Marginal biopsies taken demonstrated integration of neo-cartilage to adjacent cartilage.

Conclusions This study although with a limited sample, demonstrates the viability of ACI as treatment for osteochondral defects of the talus. Short-term results demonstrated clinical improvement from pre-operative to post-operative condition compatible with findings at second-look arthroscopy and histologic examination.