2025 ISAKOS Biennial Congress ePoster
Comparative Clinical and Radiographic Outcomes of Particulated Juvenile Articular Cartilage Implantation in Shouldered and Unshouldered Patella Cartilage Lesions
Ryann Davie, MD, New York, NY UNITED STATES
Brittany Margaret Ammerman, MD, MBS, New York, NY UNITED STATES
Bennett Propp, BS, Westport, CT UNITED STATES
Erick Marigi, MD, Jacksonville, Florida UNITED STATES
William A. Marmor, MD, Miami, FL UNITED STATES
Kiera A. Kingston, MD, Chicago, IL UNITED STATES
Natalie K. Pahapill, BS, New York, NY UNITED STATES
Alissa J. Burge, MD, New York, NY UNITED STATES
Audrey Christine Wimberly, MPH, New York, NY UNITED STATES
Joseph T. Nguyen, MPH, New York, NY UNITED STATES
Elizabeth Rose Dennis, MD MS, Brooklyn, NY UNITED STATES
Beth Ellen Shubin Stein, MD, New York, NY UNITED STATES
Hospital for Special Surgery, New York, New York, UNITED STATES
FDA Status Not Applicable
Summary
This study presents the comparison of clinical and radiographic outcomes of particulated juvenile articular cartilage in patients with shouldered versus unshouldered full-thickness cartilage defects of the patella.
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Abstract
Background
Particulated juvenile articular cartilage (PJAC) has demonstrated promising early results in the treatment of symptomatic articular defects of the patella. However, some uncertainty exists regarding the stability of this cell-based technique in lesions that are not well-contained or shouldered. The purpose of this study is to compare clinical and radiographic outcomes of PJAC in patients with shouldered versus unshouldered full-thickness cartilage defects of the patella.
Methods
A retrospective review of prospectively collected data from an institutional knee registry was conducted on patients treated with PJAC for a full-thickness symptomatic patellar cartilage lesion between March 2014 and August 2019. Cartilage defects were graded by the Outerbridge classification and characterized arthroscopically as shouldered or unshouldered. Patient reported outcome measures (PROMs) were obtained pre-operatively and post-operatively at 2-year follow-up. PROMs consisted of International Knee Documentation Committee (IKDC), Kujala, Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS Quality of Life (KOOS QOL), 12-Item Short Form Survey (SF-12), Veterans Rand 12 Item Health Survey (VR-12), Veterans Rand 6D (VR-6D), and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS). Post-operative MRI studies were read by a musculoskeletal fellowship-trained radiologist, characterizing the percentage of fill based on both coronal and sagittal images: 0%-33%, 34%-66%, or 67%-100%.
Results
A total of 64 patients underwent PJAC implantation with 32 (50%) shouldered and 32 (50%) unshouldered defects, respectively. The cohort was predominantly female (n = 47; 73.4%) with a mean age of 26.3 years (range, 14 – 44) and mean follow-up of 2.8 ± 1.6 years. Overall, all patients demonstrated statistically significant improvements in baseline KOOS QOL, HSS Pedi Fabs, IKDC, Kujala, SF-12 Physical Health, VR-12 Physical Health, VR6D (all P < .001). Radiographically, shouldered and unshouldered defects demonstrated similar rates of cartilage fill on postoperative MRIs (P = .604). Similarly, all PROMs were equivalent between shouldered and unshouldered defects at 2-year follow-up (P>0.05). However, higher improvements were seen in KOOS-PS (27.2 vs. 10.7; P = .015) and Kujala scores (44.3 vs. 26.9; P = .039) from baseline to 2-year follow-up in the shouldered group.
Conclusion
PJAC implantation led to significantly improved PROMs for both shouldered and unshouldered patellar cartilage lesions over time. Additionally, minimal differences were observed between shouldered and unshouldered defects treated with PJAC at 2-year follow-up.