Arthroscopic second generation autologous chondrocytes implantation associated with bone grafting for the treatment of knee osteochondritis dissecans: Results at 6 years.

Purpose: The aim of this study was to analyze the clinical outcome obtained with arthroscopic second generation autologous chondrocyte implantation (ACI) associated with bone grafting for the treatment of knee osteochondritis dissecans (OCD) at medium term follow-up. Methods: Thirty-four knees affected by symptomatic OCD grade III or IV on the ICRS (International Cartilage Repair Society) scale were treated and prospectively evaluated at 12, 24 months of follow-up, and at a final mean 6 +/- 1 years of follow-up. The mean age at treatment was 21 +/- 6 years. The average size of the defects was 3 +/- 1 cm(2). Patients were evaluated with IKDC, EQ-VAS, and Tegner scores. Results: A statistically significant improvement in all scores was observed after the treatment. The IKDC subjective score improved from 38 +/- 13 to 81 +/- 20, and 91% of the knees were rated as normal or nearly normal in the objective IKDC at the final evaluation. EQ-VAS and Tegner scores showed a statistically significant linear trend of improvement over time passing from 52 +/- 18 to 83 +/- 14 and from 2 +/- 1 to 5 +/- 3, respectively, at 6 years' follow-up. A better outcome was obtained in men, sport active patients, and smaller lesions. Conclusions: Second generation ACI associated with bone grafting is a valid treatment option for knee OCD and may offer a good and stable clinical outcome at mean 6 years of follow-up. Further studies are needed to confirm the results over time, and determine if there is only a symptomatic improvement, or if this procedure may also prevent or delay further knee degeneration.