Long-term Outcomes After First-Generation Autologous Chondrocyte Implantation for Cartilage Defects of the Knee
Long-term Outcomes After First-Generation Autologous Chondrocyte Implantation for Cartilage Defects of the Knee
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DOI：
10.1177/0363546513506593
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发表时间：
2014-01-01
影响因子：
4.8
通讯作者：
Salzmann, Gian
中科院分区：
文献类型：
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作者：
Niemeyer, Philipp;Porichis, Stella;Salzmann, Gian
背景：自体软骨细胞移植(ACI)是治疗膝关节大型软骨缺损的一种公认的外科治疗方法。目的：评价ACI后的长期临床和磁共振成像(MRI)结果。研究设计：病例系列；证据水平，4。方法：1997年1月至2001年6月，共有86例患者接受ACI治疗。手术时平均年龄33.3±10.2岁，平均缺损面积6.5~4.0 cm(2)。其中股骨内侧髁34例，股骨外侧13例，滑车沟软骨损伤6例，髌骨损伤17例。平均随访10.9+/-1.1年，70例(随访率82%)82个膝关节全层软骨缺损的患者可以使用标准器械进行膝关节功能评估，其中59例患者还接受了1.5-T磁共振扫描，以量化软骨修复组织的磁共振观察(MOCART)评分。通过Lysholm评分、国际膝关节文件委员会(IKDC)评分以及膝关节损伤和骨关节炎结果评分(KOOS)来评估随访时的临床功能。患者的活动通过Tegner评分进行评估。此外，对疼痛的视觉模拟评分(VAS)和患者满意度分别进行了评估。结果：在随访时，77%的患者表示满意或非常满意。平均IKDC评分为74.0+/-17.3分。平均Lysholm评分由术前的42.0+/-22.5提高到术后的71.0+/-17.4(P<；0.01)。VAS评分由术前7.2+/-1.9降至术后2.1+/-2.1。平均MOCART评分为44.9+/-23.6。78%的病例发现缺损性骨髓水肿。然而，未发现MOCART评分与临床结果(IKDC评分)之间的相关性(Pearson系数，r=0.173)。结论：第一代ACI在患者满意度、疼痛减轻和膝关节功能改善方面具有令人满意的临床效果。然而，膝关节功能的完全恢复是不可能的。尽管MRI显示了大多数病例的病变，整体MOCART评分似乎中等，但这与长期临床结果无关。
Background: Autologous chondrocyte implantation (ACI) represents an established surgical therapy for large cartilage defects of the knee joint. Although various studies report satisfying midterm results, little is known about long-term outcomes.Purpose: To evaluate long-term clinical and magnetic resonance imaging (MRI) outcomes after ACI.Study Design: Case series; Level of evidence, 4.Methods: Between January 1997 and June 2001, a total of 86 patients were treated with ACI for isolated cartilage defects of the knee. The mean patient age at the time of surgery was 33.3 10.2 years, and the mean defect size was 6.5 4.0 cm(2). Thirty-four defects were located on the medial femoral condyle and 13 on the lateral femoral condyle, while 6 patients were treated for cartilage defects of the trochlear groove and 17 for patellar lesions. At a mean follow-up of 10.9 +/- 1.1 years, 70 patients (follow-up rate, 82%) treated for 82 full-thickness cartilage defects of the knee were available for an evaluation of knee function using standard instruments, while 59 of these patients were additionally evaluated by 1.5-T MRI to quantify the magnetic resonance observation of cartilage repair tissue (MOCART) score. Clinical function at follow-up was assessed by means of the Lysholm score, the International Knee Documentation Committee (IKDC) score, and the Knee injury and Osteoarthritis Outcome Score (KOOS). Patient activity was assessed by the Tegner score. In addition, pain on a visual analog scale (VAS) and patient satisfaction were evaluated separately.Results: At follow-up, 77% reported being satisfied or very satisfied. The mean IKDC score at follow-up was 74.0 +/- 17.3. The mean Lysholm score improved from 42.0 +/- 22.5 before surgery to 71.0 +/- 17.4 at follow-up (P < .01). The mean pain score on the VAS decreased from 7.2 +/- 1.9 preoperatively to 2.1 +/- 2.1 postoperatively. The mean MOCART score was 44.9 +/- 23.6. Defect-associated bone marrow edema was found in 78% of the cases. Nevertheless, no correlation between the MOCART score and clinical outcome (IKDC score) could be found (Pearson coefficient, r = 0.173).Conclusion: First-generation ACI leads to satisfying clinical results in terms of patient satisfaction, reduction of pain, and improvement in knee function. Nevertheless, full restoration of knee function cannot be achieved. Although MRI reveals lesions in the majority of the cases and the overall MOCART score seems moderate, this could not be correlated with long-term clinical outcomes.