Arthroscopic Treatment of Osteochondral Lesions of the Ankle With Matrix-Associated Chondrocyte Implantation Early Clinical and Magnetic Resonance Imaging Results
Arthroscopic Treatment of Osteochondral Lesions of the Ankle With Matrix-Associated Chondrocyte Implantation Early Clinical and Magnetic Resonance Imaging Results
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DOI：
10.1177/0363546510381575
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发表时间：
2011-02-01
影响因子：
4.8
通讯作者：
Blackney, Mark
中科院分区：
文献类型：
--
作者：
Aurich, Matthias;Bedi, Harvinder S.;Blackney, Mark
背景资料：传统的自体软骨细胞移植在踝关节往往需要胫骨或腓骨截骨术与潜在的发病率的病人。生物技术和外科技术的进步导致基质相关软骨细胞植入（MACI）的发展。由于软骨细胞负载的支架可以在关节镜下应用，该手术对于治疗踝关节骨软骨缺损特别有用。假设：关节镜下MACI在踝关节是一种安全的手术，具有良好的临床和磁共振成像结果。研究设计：病例系列;证据等级，4.方法：作者回顾了2006年2月至2008年5月期间因踝关节骨软骨病变（n = 19）而接受关节镜MACI的所有患者（n = 18）的临床和磁共振成像。使用足部功能指数（FFI）的疼痛和残疾模块、美国矫形足踝协会（AOFAS）临床评级系统、美国矫形外科医师学会（AAOS）下肢结局评估工具的足踝模块核心量表和腕关节修复组织的磁共振观察（MOCART）评分。MACI术后3年的临床结果14例患者术后随访24.5个月，与术前资料及19例患者的MRI资料进行比较。（50.3% +/- 13.2%）的所有临床评分（MACI前FFI疼痛：5.5 +/- 2.0，MACI后：2.8 +/- 2.2; MACI前FFI功能障碍：5.0 +/- 2.3，MACI后：2.6 +/- 2.2; MACI前AOFAS：58.6 +/- 16.1，MACI后：80.4 +/- 14.1; MACI前AAOS标准化平均值：59.9 +/- 16.0，MACI后：83.5 +/- 13.2; MACI前AAOS标准化评分：23.0 +/- 13.0，MACI后：42.2 +/- 10.7）。根据AOFAS后足评分，64%被评为优秀和良好，而36%被评为一般和差。结果与患者年龄和症状持续时间相关，但与病变大小无关。16名患者（89%）报告在症状发作前定期进行体育活动;其中13名（81%）在MACI后恢复运动，56%（n = 9）恢复到相同水平。平均MOCART评分为62.4 ± 15.8分。在一般情况下，有没有MOCART评分和临床结果之间的关系，虽然填充的缺陷表现出一定的相关性与AAOS score.Conclusion：关节镜下MACI是一个安全的程序，治疗骨软骨病变的踝关节整体良好的临床和磁共振成像结果。
Background: Conventional autologous chondrocyte transplantation in the ankle often requires tibial or fibular osteotomies with potential morbidity for the patient. Advances in biotechnology and surgical techniques have resulted in the development of matrix-associated chondrocyte implantation (MACI). As the chondrocyte-loaded scaffold can be applied arthroscopically, this procedure is especially useful for the treatment of osteochondral defects in the ankle.Hypothesis: Arthroscopic MACI is a safe procedure in the ankle with good clinical and magnetic resonance imaging results.Study Design: Case series; Level of evidence, 4.Methods: The authors reviewed all patients (n = 18) who had arthroscopic MACI for osteochondral lesions of the ankle (n = 19) between February 2006 and May 2008 clinically and with magnetic resonance imaging. The pain and disability module of the Foot Function Index (FFI), the American Orthopaedic Foot & Ankle Society (AOFAS) clinical rating system, the Core Scale of the Foot and Ankle Module of the American Academy of Orthopaedic Surgeons (AAOS) Lower Limb Outcomes Assessment Instruments, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score were used. The clinical results up to 3 years after MACI (mean follow-up, 24.5 months) were compared with preoperative data for 14 cases and the magnetic resonance imaging data for all 19.Results: A significant improvement (50.3% +/- 13.2%) in all clinical scores was noted (FFI pain before MACI: 5.5 +/- 2.0, after MACI: 2.8 +/- 2.2; FFI disability before MACI: 5.0 +/- 2.3, after MACI: 2.6 +/- 2.2; AOFAS before MACI: 58.6 +/- 16.1, after MACI: 80.4 +/- 14.1; AAOS standardized mean before MACI: 59.9 +/- 16.0, after MACI: 83.5 +/- 13.2; AAOS normative score before MACI: 23.0 +/- 13.0, after MACI: 42.2 +/- 10.7). According to the AOFAS Hindfoot score, 64% were rated as excellent and good, whereas 36% were rated fair and poor. The results correlated with the age of the patient and the duration of symptoms, but not with the size of the lesion. Sixteen patients (89%) reported regular sports activities before the onset of symptoms; 13 of them (81%) returned to sports after the MACI, 56% (n = 9) to the same level. The mean MOCART score was 62.4 +/- 15.8 points. In general, there was no relation between MOCART score and clinical outcome, although the filling of the defect showed some correlation with the AAOS score.Conclusion: Arthroscopic MACI is a safe procedure for the treatment of osteochondral lesions in the ankle with overall good clinical and magnetic resonance imaging results.