Two- to 9-year outcome after autologous chondrocyte transplantation of the knee
Two- to 9-year outcome after autologous chondrocyte transplantation of the knee
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DOI：
10.1097/00003086-200005000-00020
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发表时间：
2000-05-01
影响因子：
4.2
通讯作者：
Lindahl, A
中科院分区：
文献类型：
--
作者：
Peterson, L;Minas, T;Lindahl, A
自1987年瑞典开始采用自体培养软骨细胞移植治疗膝关节大面积（1.5-12.0 cm（2））全层软骨缺损。本研究报告了采用该技术治疗的前101例患者的临床、关节镜和组织学结果。使用三种类型的终点对患者进行回顾性评估：患者和医生衍生的临床评定量表（五种经验证的量表和两种新量表）;关节镜下软骨填充、整合和表面硬度评估;以及标准组织化学技术。94例随访2- 9年的患者可评价。在各组中观察到良好至极佳的临床结果，如下所示：孤立性股骨髁（92%）、多发性病变（67%）、剥脱性骨软骨炎（89%）、髌骨（65%）和股骨髁伴前交叉韧带修复（75%），53例接受评价的患者的关节镜检查结果显示修复组织填充良好，与下层骨的粘附良好，与邻近软骨无缝结合，硬度接近邻近组织。在26例关节镜检查中发现了骨膜或移植物或两者的肥大反应; 7例有症状，在关节镜修整后消退，7例（前23例中的4例和后78例中的3例）患者发生移植物失效。37例活检标本的组织学分析显示透明样组织（透明基质染色阳性，II型胶原蛋白，缺乏纤维成分）和良好至优异的临床结果之间存在相关性。本研究中自体软骨细胞移植的良好临床结果令人鼓舞，正在进行临床试验以评估与传统纤维软骨修复技术相比的结果。
Autologous cultured chondrocyte transplantation was introduced in Sweden in 1987 for the treatment of large (1.5-12.0 cm(2)) full thickness chondral defects of the knee, The clinical, arthroscopic, and histologic results from the first 101 patients treated using this technique are reported in this study. Patients were assessed retrospectively using three types of endpoints: patient and physician derived clinical rating scales (five validated and two new); arthroscopic assessment of cartilage fill, integration, and surface hardness; and standard histochemical techniques. Ninety-four patients with 2- to 9-years followup were evaluable. Good to excellent clinical results were seen in individual groups as follows: isolated femoral condyle (92%), multiple lesions (67%), osteochondritis dissecans (89%), patella (65%), and femoral condyle with anterior cruciate ligament repair (75%), Arthroscopic findings in 53 evaluated patients showed good repair tissue fill, good adherence to underlying bone, seamless integration with adjacent cartilage, and hardness close to that of the adjacent tissue. Hypertrophic response of the periosteum or graft or both was identified in 26 arthroscopies; seven were symptomatic and resolved after arthroscopic trimming, Graft failure occurred in seven (four of the first 23 and three of the next 78) patients. Histologic analysis of 37 biopsy specimens showed a correlation between hyalinelike tissue (hyaline matrix staining positive for Type II collagen and lacking a fibrous component) and good to excellent clinical results, The good clinical outcomes of autologous chondrocyte transplantation in this study are encouraging, and clinical trials are being done to assess the outcomes versus traditional fibrocartilage repair techniques.