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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Outcomes of Autologous Chondrocyte Implantation in the Knee following Failed Microfracture
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Outcomes of Autologous Chondrocyte Implantation in the Knee following Failed Microfracture

机译：微骨折失败后膝关节自体软骨细胞植入的结果

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Objectives: Marrow stimulation techniques such as drilling or microfracture are first-line treatment options for symptomatic cartilage defects of the knee. For young patients who have failed microfracture, cartilage restoration techniques such as autologous chondrocyte implantation (ACI), OATS, and osteochondral allograft and are frequently employed. Nevertheless, there a few reports in the literature evaluating the results of ACI following failed microfracture and those available suggest inferior outcomes compared to primary ACI. This study was performed to evaluate the clinical outcomes of autologous chondrocyte implantation (ACI) following failed microfracture in the knee and compare these outcomes to those of primary ACI. Methods: Patients were identified who underwent autologous chondrocyte implantation for symptomatic chondral lesions of the knee refractory to previous microfracture. Postoperative data were collected using several subjective scoring systems (Noyes, Tegner, Lysholm, IKDC, KOOS, SF12). An age-matched cohort of 103 patients who underwent primary ACI of the knee was used as a control group. Statistics were performed in a paired manner using a Student’s t-test for ordinal data and chi-square test for categorical data. Results: Ninety-two patients met the inclusion criteria. The average patient age was 30.1 years (range, 14-49 years) at the time of ACI. The average duration from microfracture to ACI was 21.2 months (range, 1-88 months). ACI was performed in the tibiofemoral compartment in 42 patients, the patellofemoral compartments in 38 patients, and in both in 12 patients. The primary lesion treated with ACI involved the MFC in 38 patients, the trochlea in 25 patients, the patella in 19 patients, and the LFC in 10 patients. The lesions averaged 467mm3 in the trochlea, 445mm3 in the LFC, 265mm3 in the patella, and 295mm3 in the patella. Nineteen patients underwent concurrent ACI to multiple lesions. Thirty-one patients underwent concomitant patellar anteromedialization, 9 patients underwent meniscal allograft, and 6 underwent realignment ostetomies (5 HTO, 1 DFO). Follow-up was available on 84 of 92 patients (91%) at an average length of follow-up of 47 months (range, 24-102 months). The control group of patients was well matched with regard to age, gender, BMI, workers compensation status, and preoperative subjective scores. Failure, defined by need for further cartilage restoration or knee arthroplasty, occurred in 8 patients (3 osteochondral allograft, 3 TKA, 1 revision ACI, 1 Denovo NT). Seventeen additional patients underwent reoperation for intra-articular debridement. There was no difference between the failure rate (8.7% v. 2.9%, p=0.21) or reoperation rate (27.2% v. 27.2%, p=0.98) in the study and control groups. For the study group, significant improvements were witnessed postoperatively for all measured questionairre parameters. No significant differences were witnessed between the study and control groups (p>0.05) with regard to any of the postoperative subjective parameters (Figure). Conclusion: In patients with discrete articular cartilage lesions of the knee and history of failed microfracture, ACI may render favorable clinical outcomes comparable to primary ACI. While other series have demonstrated inferior results following previous microfracture, our series suggests that in appropriately selected patients ACI may be used successfully as a second line treatment following failed microfracture.
机译：目标：诸如钻孔或微骨折之类的骨髓刺激技术是膝盖症状性软骨缺损的一线治疗选择。对于微骨折失败的年轻患者，经常使用软骨修复技术，例如自体软骨细胞植入（ACI），OATS和骨软骨移植。尽管如此，文献中仍有一些报告评估了微骨折失败后的ACI结果，而现有的报告表明，与原发性ACI相比，结果较差。这项研究的目的是评估膝关节微骨折失败后自体软骨细胞植入（ACI）的临床结果，并将这些结果与原发性ACI进行比较。方法：确定患有自体软骨细胞植入术的患者，该患者因先前的微骨折难治性膝关节症状性软骨损伤。使用几种主观评分系统（Noyes，Tegner，Lysholm，IKDC，KOOS，SF12）收集术后数据。年龄匹配的103例行膝关节原发性ACI的患者作为对照组。使用学生的t检验（序数数据）和卡方检验（分类数据）以配对的方式进行统计。结果：92例患者符合纳入标准。发生ACI时，患者平均年龄为30.1岁（14-49岁）。从微骨折到ACI的平均持续时间为21.2个月（范围1-88个月）。在42例患者的胫股室中进行ACI，在38例患者的the股室中进行，在12例患者中均进行了ACI。 ACI治疗的原发灶包括MFC 38例，滑车25例，the骨19例和LFC 10例。病变在滑车中平均为467mm3，在LFC中平均为445mm3，在pat骨中平均为265mm3，在pat骨中平均为295mm3。 19例患者同时接受ACI损伤。 31例患者同时进行了pa骨抗骨化术，9例患者进行了半月板同种异体移植，6例患者接受了重新整形术（5 HTO，1 DFO）。对92位患者中的84位（91％）进行了随访，平均随访时间为47个月（范围24-102个月）。对照组的患者在年龄，性别，BMI，工人补偿状况和术前主观评分方面均很匹配。有8例患者发生了失败，其定义为需要进一步进行软骨修复或膝关节置换术（3例软骨软骨移植，3例TKA，1例ACI修订版，1例Denovo NT）。另外十七名患者因关节内清创术而再次手术。研究组和对照组的失败率（8.7％vs. 2.9％，p = 0.21）或再次手术率（27.2％vs. 27.2％，p = 0.98）之间没有差异。对于研究组，所有测量到的Questairair参数在术后均得到了明显改善。在任何术后主观参数方面，研究组与对照组之间均未观察到显着差异（p> 0.05）（图）。结论：对于膝关节离散性软骨损伤和微骨折失败史的患者，ACI可以提供与原发性ACI相当的良好临床效果。虽然其他系列已经证明以前的微创以下较差的结果，我们的系列表明，在适当选择ACI患者可以成功如下失败微创第二线治疗。

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