Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study
Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study
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DOI：
10.1007/s00167-009-1028-1
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发表时间：
2010-04-01
影响因子：
3.8
通讯作者：
Steinmeyer, Juergen
中科院分区：
文献类型：
--
作者：
Basad, Erhan;Ishaque, Bernd;Steinmeyer, Juergen
大约12%的人群发生腕关节缺陷，并可能导致显著的功能障碍和生活质量下降。各种手术治疗的证据是不确定的。本研究旨在比较接受基质诱导自体软骨细胞植入（MACI（TM）或微骨折（MF）治疗的症状性软骨缺损患者的临床结果。纳入的患者为50岁以下的有症状、创伤后、单一、孤立的软骨缺损（4-10 cm（2））的千分之一日元18和千分之一货币符号，并随机接受MACI（TM）或MF。术后随访8-12周、22-26周和50-54周，评价疗效和安全性。结果指标为Tegner、Lysholm和ICRS评分。一项随机研究纳入了60名患者（40名MACI（TM），20名MF）。两个治疗组的Lysholm、Tegner、患者ICRS和外科医生ICRS评分在基线和术后24个月之间存在显著差异（均P < 0.0001）。然而，根据Lysholm（P = 0.005）、Tegner（P = 0.04）、ICRS患者（P = 0.03）和ICRS外科医生（P = 0.02）评分，随着时间的推移（24个月与基线相比），MACI（TM）的有效性显著高于MF。在研究期间没有与MACI（TM）或MF相关的安全性问题。MACI（TM）在2年以上的关节缺损治疗中上级优于MF。MACI（TM）和MF是互补的程序，取决于缺陷的大小和症状复发。MACI（TM）技术在可重复性、安全性、术中时间、手术简单性和减少侵入性方面，代表了对外科医生、患者、医疗保健机构和支付者而言，第一代和第二代基于软骨细胞的软骨修复技术的重大进步。
Cartilage defects occur in approximately 12% of the population and can result in significant function impairment and reduction in quality of life. Evidence for the variety of surgical treatments available is inconclusive. This study aimed to compare the clinical outcomes of patients with symptomatic cartilage defects treated with matrix-induced autologous chondrocyte implantation (MACI (TM) or microfracture (MF). Included patients were a parts per thousand yen18 and a parts per thousand currency sign50 years of age with symptomatic, post-traumatic, single, isolated chondral defects (4-10 cm(2)) and were randomised to receive MACI (TM) or MF. Patients were followed up 8-12, 22-26 and 50-54 weeks post-operatively for efficacy and safety evaluation. Outcome measures were the Tegner, Lysholm and ICRS scores. Sixty patients were included in a randomised study (40 MACI (TM), 20 MF). The difference between baseline and 24 months post-operatively for both treatment groups was significant for the Lysholm, Tegner, patient ICRS and surgeon ICRS scores (all P < 0.0001). However, MACI (TM) was significantly more effective over time (24 months versus baseline) than MF according to the Lysholm (P = 0.005), Tegner (P = 0.04), ICRS patient (P = 0.03) and ICRS surgeon (P = 0.02) scores. There were no safety issues related to MACI (TM) or MF during the study. MACI (TM) is superior to MF in the treatment of articular defects over 2 years. MACI (TM) and MF are complementary procedures, depending on the size of the defect and symptom recurrence. The MACI (TM) technique represents a significant advance over both first and second generation chondrocyte-based cartilage repair techniques for surgeons, patients, health care institutions and payers in terms of reproducibility, safety, intraoperative time, surgical simplicity and reduced invasiveness.