High-density autologous chondrocyte implantation in an elite 60-year-old professional ballet dancer: case report

Articular cartilage injuries represent a major challenge in elite dancers due to the extreme mechanical demands placed on the knee joint. Although an age limit of approximately 55 years is commonly considered for Autologous Chondrocyte Implantation (ACI), chronological age may not accurately reflect the true regenerative potential of highly trained athletes. We report the case of a 60-year-old elite professional Spanish dancer who presented with a symptomatic chondral lesion measuring 1.8 × 1 cm in the medial femoral condyle. Although the patient was older than the conventional age limit typically considered for ACI, his overall biological status and maintained athletic performance made him a suitable candidate for High-Density ACI (HD-ACI). Three years after surgery, the patient remains fully active in professional dance activity, with no pain and no functional impairment. The International Knee Documentation Committee (IKDC) score improved from 18 preoperatively to 94 at final follow-up. Twelve-month follow-up MRI (Magnetic Resonance Imaging) showed complete filling of the defect, along with improvement of the underlying subchondral bone. In conclusion, HD-ACI can be an effective regenerative option for elite master athletes when biological condition and chondrocyte culture quality are optimal, regardless of chronological age. This case suggests that chronological age alone may not adequately reflect the biological suitability for regenerative cartilage procedures in selected high-performance athletes, in whom biological condition and functional demands may also influence clinical outcome. LEVEL OF EVIDENCE: V.