Second-generation arthroscopic autologous chondrocyte implantation for the treatment of degenerative cartilage lesions
Second-generation arthroscopic autologous chondrocyte implantation for the treatment of degenerative cartilage lesions
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DOI：
10.1007/s00167-011-1732-5
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发表时间：
2012-09-01
影响因子：
3.8
通讯作者：
Marcacci, Maurilio
中科院分区：
文献类型：
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作者：
Filardo, Giuseppe;Kon, Elizaveta;Marcacci, Maurilio
退行性软骨病变提供了一个负面的关节环境，这可能对软骨再生的过程产生负面影响。本研究的目的是分析第二代关节镜自体软骨细胞植入（ACI）治疗孤立性退行性膝关节软骨病变的临床结果。58例受股骨髁和胫骨托局灶性退行性软骨病变影响的连续患者接受了第二代关节镜ACI治疗。手术时的平均年龄为34.7 +/-A9.1岁，平均缺损尺寸为2.3 +/-A0.9 cm（2）。在术前、术后2年和术后6年采用IKDC、EQ-VAS和Tegner评分对患者进行前瞻性评估，从基础评估到最终随访，所有评分均观察到统计学显著改善。在2年和6年随访时，IKDC主观评分分别从39.3 +/- A 13.6改善至68.8 +/- A 22.7和68.5 +/- A 23.9，随着时间的推移具有显著改善（P < 0.0005）和稳定的结果; EQ-VAS和Tegner评分证实了相同的趋势。结果最差的是低体力活动水平的患者、女性和既往接受过手术的患者，而手术前的症状持续时间并不影响最终结果。失败率为18.5%，尽管有显著改善，但就不同研究人群报告的结局而言，结果较低，失败的数量也明显较高。组织工程化软骨植入是治疗退行性软骨病变的一种很有前途的方法，但移植物的性能，除了机械和生物化学关节环境，必须得到改善。
Degenerative cartilage lesions present a negative joint environment, which may have a negative effect on the process of cartilage regeneration. The aim of this study is to analyze the clinical outcome obtained with the treatment for isolated degenerative knee cartilage lesions by second-generation arthroscopic autologous chondrocyte implantation (ACI).Fifty-eight consecutive patients affected by focal degenerative chondral lesions of the femoral condyles and trochlea were treated by second-generation arthroscopic ACI. The mean age at surgery was 34.7 +/- A 9.1 years and the average defect size was 2.3 +/- A 0.9 cm(2). The patients were prospectively evaluated with IKDC, EQ-VAS, and Tegner scores preoperatively, at 2 and 6 years.A statistically significant improvement was observed in all scores from the basal evaluation to the final follow-up. The IKDC subjective score improved from 39.3 +/- A 13.6 to 68.8 +/- A 22.7 and 68.5 +/- A 23.9 at the 2- and 6-year follow-ups, respectively, with a significant improvement (P < 0.0005) and stable results over time; the same trend was confirmed by the EQ-VAS and Tegner scores. The worst results were found in patients with a low physical activity level, women, and those having undergone previous surgery, whereas the symptom duration before surgery did not influence the final outcome. The failure rate was 18.5%.Despite a significant improvement, the results were lower with respect to the outcome reported in different study populations, and the number of failures was markedly higher, too. Tissue-engineered cartilage implantation is a promising approach for the treatment of degenerative chondral lesions, but graft properties, besides mechanical and biochemical joint environment, have to be improved.Case series, Level IV.