Clinical Outcome of Autologous Chondrocyte Implantation for Failed Microfracture Treatment of Full-Thickness Cartilage Defects of the Knee Joint
Clinical Outcome of Autologous Chondrocyte Implantation for Failed Microfracture Treatment of Full-Thickness Cartilage Defects of the Knee Joint
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DOI：
10.1177/0363546511425651
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发表时间：
2012-02-01
影响因子：
4.8
通讯作者：
Niemeyer, Philipp
中科院分区：
文献类型：
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作者：
Pestka, Jan M.;Bode, Gerrit;Niemeyer, Philipp
背景：虽然已经确定了影响自体软骨细胞植入(ACI)术后结果的各种因素，但先前对软骨缺损的治疗及其对二线ACI预后的影响尚未得到充分评估。假设：关节镜下微骨折失败后，作为二线治疗的自体软骨细胞植入与作为一线治疗的ACI相比，失败率更高，临床结果更差。研究设计：队列研究；方法：对28例膝关节孤立性软骨缺损患者在一线治疗失败(失败定义为需要再次干预)后行ACI治疗。这些患者被分配到A组，并与年龄、缺陷大小和缺陷位置相同的配对队列患者(B组)进行比较，在B组中，ACI被作为一线治疗。对两组的失败率进行评估。术后膝关节状况用国际膝关节文献委员会(IKDC)评分、膝关节损伤和骨关节炎结果评分(KOOS)进行评定，并用活动评定量表评定运动能力。平均随访时间：A组48.0个月(15.1~75.1个月)，B组41.4个月(15.4~83.6个月)。结果：A组失败率(7/28例)显著高于B组(1/28例，P=0.0241)。术后平均(SD)IKDC评分A组为58.4(22.4)分，B组为69.0[19.1]分(P=0.0583)。在Koos疼痛和日常生活能力两个子量表上有显著差异，而其余Koos子量表没有显著差异。尽管A组的失败率明显较高，但这些患者参加的活动并不少，体力活动的频率或强度也没有降低。结论：与作为一线治疗的ACI相比，微骨折失败后自体软骨细胞植入的失败率明显更高，临床结果更差。
Background: Although various factors have been identified that influence outcome after autologous chondrocyte implantation (ACI), the relevance of prior treatment of the cartilage defect and its effect concerning the outcome of second-line ACI have not been evaluated to a full extent.Hypothesis: Autologous chondrocyte implantation used as a second-line treatment after failed arthroscopic microfracturing is associated with a higher failure rate and inferior clinical results compared with ACI as a first-line treatment.Study Design: Cohort study; Level of evidence, 3.Methods: A total of 28 patients with isolated cartilage defects at the knee joint were treated with ACI after microfracture as a first-line treatment had failed (failure defined as the necessity of reintervention). These patients were assigned to group A and compared with a matched-pair cohort of patients of identical age, defect size, and defect location (group B) in which ACI was used as a first-line treatment. Failure rates in both groups were assessed. Postoperative knee status was evaluated with the International Knee Documentation Committee (IKDC) score and Knee injury and Osteoarthritis Outcome Score (KOOS), and sporting activity was assessed by use of the Activity Rating Scale. Mean follow-up times were 48.0 months (range, 15.1-75.1 months) in group A and 41.4 months (range, 15.4-83.6 months) in group B. Differences between groups A and B were analyzed by Student t test.Results: Group A had significantly greater failure rates (7 of 28 patients) in comparison with group B (1 of 28 patients; P=.0241). Mean (SD) postoperative IKDC scores revealed 58.4 (22.4) points in group A with a trend toward higher score results (69.0 [19.1] points) for patients in group B (P=.0583). Significantly different results were obtained for KOOS pain and activity of daily living subscales, whereas the remaining KOOS subscales did not show significant differences. Despite the significantly higher failure rate observed in group A, those patients did not participate in fewer activities or perform physical activity less frequently or at a lower intensity.Conclusion: Autologous chondrocyte implantation after failed microfracturing appears to be associated with a significantly higher failure rate and inferior clinical outcome when compared with ACI as a first-line treatment.