Clinical outcome and T2 assessment following autologous matrix-induced chondrogenesis in osteochondral lesions of the talus
Clinical outcome and T2 assessment following autologous matrix-induced chondrogenesis in osteochondral lesions of the talus
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DOI：
10.1007/s00264-015-2988-z
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发表时间：
2016-01-01
影响因子：
2.7
通讯作者：
Niemeyer, Philipp
中科院分区：
文献类型：
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作者：
Kubosch, Eva Johanna;Erdle, Benjamin;Niemeyer, Philipp
目的距骨软骨病变（ocl）治疗的科学证据有限。本研究的目的是评估一步自体软骨下松质骨移植和自体基质诱导软骨形成（AMIC）在距骨内侧ocl中的临床结果和修复组织（RT）的评估。方法17例内侧距骨OCL患者（女8例，男9例，平均年龄38.8±15.7岁）行手术治疗。平均随访39.5 +/- 18.4个月后进行临床和影像学评估，包括建立评分系统（美国骨科足踝学会[AOFAS]评分、足部功能指数[FFI]、视觉模拟量表[VAS]）、软骨修复组织磁共振观察评分系统（MOCART评分）评估和T2制图。结果术前疼痛（7.8 +/- 2.1）明显改善至术后平均3.2 +/- 2.4。AOFAS平均得分为82.6 +/- 13.4，MOCART平均得分为52.7 +/- 15.9。RT的T2弛缓时间平均为41.6 +/- 6.3 ms，与周围软骨无显著差异（平均38.8 +/- 8.5;p = 0.58）。MOCART评分与AOFAS评分显著相关（rho = 0.574, p = 0.040）。RT T2弛豫时间与MOCART评分显著相关（rho = 0.593, p = 0.033）。结论自体软骨下松质骨一步植入术联合AMIC可显著减轻术后疼痛，术后功能预后满意。磁共振成像（MRI）评估显示再生组织质量良好，与周围软骨的MRI超微结构相似。
Purpose Scientific evidence for the treatment of osteochondral lesions (OCLs) of the talus is limited. The aim of this study was an evaluation of the clinical outcome after a one-step autologous subchondral cancellous bone graft and autologous matrix-induced chondrogenesis (AMIC) in medial OCLs of the talus and the assessment of the repair tissue (RT).Methods Seventeen patients (eight women, nine men; mean age, 38.8 +/- 15.7 years) with an OCL of the medial talus underwent surgery. Clinical and radiological assessment was performed after a mean follow-up of 39.5 +/- 18.4 months, including established scoring systems (American Orthopaedic Foot and Ankle Society [AOFAS] Score, Foot Function Index [FFI], visual analogue scale [VAS]), evaluation of Magnetic Resonance Observation of Cartilage Repair Tissue scoring system (MOCART Score) and T2 mapping.Results Preoperative pain (7.8 +/- 2.1) significantly improved to an average of 3.2 +/- 2.4 postoperatively. AOFAS Score averaged 82.6 +/- 13.4, MOCART Score 52.7 +/- 15.9. Mean T2 relaxation time of the RT was 41.6 +/- 6.3 ms and showed no significant differences to the surrounding cartilage (mean, 38.8 +/- 8.5; p = 0.58). MOCART Score significantly correlated with the AOFAS Score (rho = 0.574, p = 0.040). T2 relaxation time of the RT significantly correlated with the MOCART Score (rho = 0.593, p = 0.033).Conclusions The one-step autologous subchondral cancellous bone grafting and AMIC leads to a significant reduction in postoperative pain and satisfying postoperative functional outcome in mid-term follow-up. Magnetic resonance imaging (MRI) assessment demonstrated a good quality of regenerative tissue similar to the MRI ultrastructure of the surrounding cartilage.