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Matrix-induced Autologous Chondrocyte Implantation in the Patellofemoral Compartment

February 10, 2018

Contributors: Amos Dai, BS; Guillem Gonzalez-Lomas, MD; Dylan Lowe, MD; Dylan Lowe, MD

Purpose: Articular cartilage lesions in the patellofemoral compartment typically result from patellofemoral malalignment or trauma, leading to the insidious onset of pain and swelling with athletic activity. These injuries may have a profound effect on quality of life, with patients often complaining of severe anterior knee pain. In general, these injuries do not heal spontaneously. Traditional surgical treatment options include débridement, microfracture, osteochondral autografting or allografting, and autologous chondrocyte implantation. Matrix-induced autologous chondrocyte implantation (MACI) is a relatively newer treatment option that addresses a number of limitations associated with autologous chondrocyte implantation, namely chondrocytes de-differentiating into fibroblasts that produce fibrocartilage, pooling of chondrocytes in some areas of the defect because of liquid cell suspension, and long surgical times because of patches that require tedious suturing. MACI involves the use of a tissue-engineered biodegradable scaffold for chondrocyte implantation, which is held in place over the defect with the use of fibrin glue. This three-dimensional culture system does not require suturing. This video reviews the indications and surgical technique for MACI for the repair of chondral defects in the patellofemoral compartment. Methods: This video presents two case studies. The first case study discusses a 33-year-old woman who is a roller derby athlete and has experienced right anterior knee pain for many years. She underwent anterior cruciate ligament and posterolateral corner reconstruction 4 years ago and underwent revision anterior cruciate ligament surgery 1 year ago. Imaging studies revealed a large chondral defect on the trochlear chondral defect. The second case study discusses a 30-year-old woman who has experienced chronic retropatellar pain in her right knee since childhood; crepitus and grind; frequent knee swelling; and pain when wearing heels, getting up from a seated position, and descending stairs. Physical examination findings revealed patellar crepitus and grind. Imaging studies revealed a full-thickness lateral patellar facet chondral lesion. The patient history, physical examination findings, and imaging studies for these two patients are discussed. Both patients elected to proceed with surgical treatment consisting of anteriorization of the tibial tubercle and MACI for repair of the patellofemoral chondral defects. Results: The MACI technique is highly efficient with regard to intraoperative time, allowing for complete and accurate repair of the chondral defect and excellent horizontal and vertical matching at the border of the implant and defect edge. The implant remains intact after intraoperative knee joint cycling. Conclusion: Articular cartilage lesions in the patellofemoral compartment cause severe knee pain and do not generally heal without surgical treatment. MACI is a novel technique for the repair of chondral defects and addresses a number of limitations associated with autologous chondrocyte implantation that involves the use of liquid cell suspension. The video presents two case studies that demonstrate how MACI can be used to manage patellofemoral chondral defects.

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