Autologous periosteal induced chondrogenesis provides satisfying clinical and radiographic results for the treatment of focal chondral defects of the knee: a prospective case series

ABSTRACT Introduction Articular cartilage has limited intrinsic repair capacity. While autologous matrix-induced chondrogenesis typically uses porcine collagen membranes, autologous periosteal membranes offer a biological alternative. Objectives To evaluate the clinical and radiological outcomes of autologous periosteal-induced chondrogenesis (APIC) for focal femoral condyle cartilage defects. Methods This prospective observational study (2019-2022) evaluated 30 patients with focal, full-thickness femoral condyle defects (≤4 cm²). All patients underwent the APIC technique. Functional outcomes were assessed via KOOS; structural repair was evaluated using MOCART 2.0 (Magnetic Resonance Observation of Cartilage Repair Tissue_) scores on MRI. Results The cohort (28 men, 2 women; mean age 33.5 years) was followed for a mean of 28 months. All Knee Injury and Osteoarthritis Outcome Score subscales improved significantly (mean gains: +30.5 to +51.6), exceeding the 10-point minimal important change. Postoperatively, 90% of patients (n = 27) achieved high functional status, though Sports/Recreation recovery (51.0 ± 48.0) showed high variability. Three patients (10%) reported persistent limitations. MOCART 2.0 scores were significantly higher for osteochondritis dissecans (82.5 ± 5.2) and traumatic defects (78.3 ± 6.1) compared to degenerative lesions (63.7 ± 7.4; P < .01). Degenerative defects exhibited more irregular surfaces and incomplete filling compared to other etiologies. Conclusions APIC is a viable biological alternative for cartilage repair, yielding satisfactory functional and radiological results. Outcomes are better in traumatic and osteochondritis dissecans-related defects compared to degenerative lesions.