Clinical outcome and success rates of ACI for cartilage defects of the patella: a subgroup analysis from a controlled randomized clinical phase II trial (CODIS study)

Arch Orthop Trauma Surg. 2020 Jun;140(6):717-725. doi: 10.1007/s00402-019-03264-x. Epub 2019 Aug 26.


Aim: Cartilage defects of the patella are considered as a problematic entity. Purpose of the present study was to evaluate the outcome of patients treated with autologous chondrocyte implantation (ACI) for cartilage defects of the patella in comparison to patient with defects of the femoral condyles.

Patients and methods: 73 patients with a follow-up of 5 years have been included in this subgroup analysis of the randomized controlled clinical trial (RCT). In dependence of defect location, patients were divided into two groups [patella defects (n = 45) and femoral condyle defects (n = 28)]. Clinical outcome was evaluated by the means of the KOOS score at baseline and 6 weeks, 3, 6, 12, 18, 24, 36, 48 and 60 months following ACI.

Results: "Responder rate" at 60 months (improvement from baseline of > 7 points in the KOOS score) in patients with patella defects was 86.2%. All scores showed a significant improvement from baseline. While overall KOOS score at 60 months was 81.9 (SD 18.6) points in femoral condyle defects, a mean of 82.6 (SD 14.0) was observed in patella defects (p = 0.2483).

Conclusion: ACI seems an appropriate surgical treatment for cartilage defects of the patella leading to a high success rate. In this study, the clinical outcome in patients with patellar defects was even better than the already excellent results in patients with defects of the femoral condyle even though the study included relatively large defect sizes for both groups (mean defect size 6.0 ± 1.7 and 5.4 ± 1.6 for femur and patella, respectively).

Keywords: Autologous chondrocyte implantation; Cartilage lesion; Knee surgery; Patella; Randomized clinical trial.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Cartilage Diseases / surgery*
  • Cartilage, Articular / surgery*
  • Chondrocytes / transplantation*
  • Humans
  • Knee Joint / surgery
  • Transplantation, Autologous*
  • Treatment Outcome