Page 34 -

CURRENT CONCEPTS
Treating Patellofemoral Cartilage Lesions
Despite generally good and excellent clinical results, it is important to note that ACI is not FDA-approved currently in the US for treatment of patellar lesions, or for treatment of bipolar patellofemoral lesions, despite its excellent clinical results in a recent multi-center trial. Use of a synthetic type I / III collagen patch has nearly eliminated hypertrophy compared with periosteum without detrimental effects on the maturation of the neo-cartilage. However, it is important to emphasize that the long-term 20-year results published by Lars Peterson and Tom Minas include the first generation technique of using periosteum. In addition, the collagen membrane is also an off-label, surgeon directed use in the United States and must be discussed with the patient during the informed consent process.
05
Particulated Juvenile Articular Cartilage (PJAC)
The use of PJAC for articular cartilage defects is an exciting and evolving treatment option. The most commonly used product currently is (DeNovo NT Natural Tissue Graft, Zimmer Inc, Warsaw, Indiana, USA) and it consists of allograft articular cartilage from donors less than 13 years old. PJAC implantation for the treatment of cartilage lesions is performed in a manner very similar to ACI. Lesion preparation is completed in the identical fashion to ACI and a single step implantation is possible, typically with fibrin glue used to secure the cartilage cells into the defect. A large advantage to this technique is that it is a one-stage surgery. One major limitation to the use of PJAC is the lack of high quality published outcome data. The few studies that do exist regarding its use have demonstrated promising results. In a recent case series published by Farr et al., the authors reported similar results in regards to clinical outcomes and defect repair in comparison to analogous matrix-associated ACI studies.
Osteochondral Allograft (OCA)
Fresh or fresh-stored osteochondral allografts are limited to areas that have established tissue banks that can provide this tissue. They provide excellent options for osteochondral lesions in the patellofemoral joint, such as a post-traumatic defect, or an osteochondritis dissecans lesion. Generally the clinical results of osteochondral allografts have not been as good as in the femoral condyles. For these reasons osteochondral allografting of the patellofemoral joint is generally reserved as a salvage procedure in the young active patient.
06
07
32 ISAKOS NEWSLETTER 2015: Volume I