Evidence / Sources / E48
Gobbi A et al. Patellofemoral full-thickness chondral defects treated with second-generation ACI: 5 years. AJSM 2009
What it can tell you
The 2-to-5-year trajectory of patellofemoral second-generation ACI: whole-cohort gains held, but patients with patellar and multiple lesions declined between years two and five — the window after supervised rehab ends, and the single most actionable finding in the patellofemoral literature.
What it cannot
Whether the decline is preventable — nobody randomized year-three training. And this is second-generation ACI, not MACI or HD-ACI; the technique has moved since 2009.
Everything on this site that leans on E48 — 16 claims
Stage VI · Long horizon [patellofemoral]“The patellofemoral MACI cohort's gains were achieved by year two and held flat past year ten, with 90% satisfaction. But in the second-generation ACI series, patients with patellar…”Stage VI · Long horizon [patellofemoral]“Strength work through years two to five treated as part of the operation, not its aftermath — the decline window in patellar and multifocal series is exactly when most people stop.”Stage VI · Long horizon · Questions“Now that formal rehab is ending — can we set a standing annual review with strength actually measured, not just symptoms asked about?”Program · Stage II (patellofemoral)“Walking in the brace, locked in extension — The near-opposite of the tibiofemoral rule on which variable is rationed. If your surgeon restricted your weight-bearing, theirs wins — …”Program · Stage VI (patellofemoral)“Years two to five, on purpose — At 12.6 years, 93% of a patellofemoral ACI cohort would choose the operation again. The knees that got there were not the ones that stopped at month…”Program · Stage VI (patellofemoral) · Gates“Strength work through years two to five treated as part of the operation, not its aftermath”Exercise Library · Years two to five“In a second-generation implantation series, patients with patellar and multiple lesions declined between years two and five, while separate long-term patellofemoral cohorts maintai…”What we don't know · № 19“No rehabilitation protocol of any kind addresses a knee with grafts in both compartments at once.”Multifocal disease · what the long-term literature shows“In the five-year patellofemoral series the whole cohort stayed well above where it started, but it did not hold flat: mean IKDC ran 46.1 before surgery to 77.1 at two years and bac…”Week ruler · week 8 (patellofemoral)“An Italian patellofemoral series reaches ninety degrees at four weeks and full range at eight. It is a week later than the Perth schedule and from an unrelated clinic — which is th…”Week ruler · week 12 (patellofemoral)“Open kinetic chain work — the knee extending against resistance with the foot free — is held back until twelve weeks in the Italian series. It is the movement that loads the kneeca…”Week ruler · week 2 (patellofemoral)“In the Italian series the leg starts taking a token amount of weight at two weeks, on two crutches, with the brace locked straight. The brace is doing the protecting: weight throug…”Week ruler · week 4 (patellofemoral)“Week four is the one point where the two independent patellofemoral protocols agree: Perth moves to about two-fifths of body weight, and the Italian series opens progressive weight…”Hard limits · stage 1 (patellofemoral)“Weight through this leg is authorised, never assumed”Hard limits · stage 2 (patellofemoral)“Full weight is a clearance, not a date”Why this · Why this is the point most people stop, and the evidence says not to“In a five-year patellofemoral series, patients with patellar and multiple lesions declined between years two and five — the window after supervised rehabilitation has ended.”
Read it like a sceptic
n=34 with subgroups of a dozen — the decline finding rests on small numbers.
Population
ACI, patellofemoral (2nd-gen)
Selection policy
Sources enter the registry through docs/research — the evidence table records design, population, and size for every entry, and pages cannot cite anything outside it.