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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Biological Knee Reconstruction With Concomitant Autologous Chondrocyte Implantation and Meniscal Allograft Transplantation
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Biological Knee Reconstruction With Concomitant Autologous Chondrocyte Implantation and Meniscal Allograft Transplantation

机译：自体软骨细胞植入和半月板同种异体移植的生物膝关节重建

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Background: Treating articular cartilage defects and meniscal deficiency is challenging. Although some short- to mid-term follow-up studies report good clinical outcomes after concurrent autologous chondrocyte implantation (ACI) and meniscal allograft transplantation (MAT), longer follow-up is needed. Purpose: To evaluate mid- to long-term outcomes after combined ACI with MAT. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective review of prospectively gathered data from patients who had undergone ACI with MAT between 1999 and 2013. A single surgeon treated 18 patients for symptomatic full-thickness chondral defects with meniscal deficiency. One patient was lost to follow-up. Thus, 17 patients (18 knees; mean age, 31.7 years) were evaluated over a mean 7.9-year follow-up (range, 2-16 years). A mean 1.8 lesions per knee were treated over a total surface area of 7.6 cm~(2)(range, 2.3-21 cm~(2)) per knee. Seventeen lateral and 1 medial MATs were performed. Survival was analyzed using the Kaplan-Meier method. The modified Cincinnati Knee Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index, visual analog scale, and Short Form–36 were used to evaluate clinical outcomes. Patients also self-reported knee function and satisfaction. Standard radiographs were scored for Kellgren-Lawrence (K-L) grade. Results: Both 5- and 10-year survival rates were 75%. Outcomes for 6 knees were considered failures. Of the 6 failures, 4 knees were converted to arthroplasty and the other 2 knees underwent biological revision surgery. Of the 12 successfully operated knees, all clinical measures significantly improved postoperatively. Ten patients representing 11 of the 12 knees rated outcomes for their knees as good or excellent, and 1 rated their outcome as fair. Eight patients representing 9 of the 12 knees were satisfied with the procedure. There was no significant osteoarthritis progression based on K-L grading from preoperatively to a mean 5.9 years after surgery. Seven of the 12 knees (58%) required subsequent surgical procedures (5 arthroscopic alone, 2 both arthroscopic and open). Conclusion: Combined ACI with MAT provided significant improvement in 65% of the operated knees over a mid- to long-term follow-up. This procedure can allow patients to retain their biological knees, delay or prevent rapid degeneration to osteoarthritis, and could be recognized as a bridge procedure before artificial knee replacement. However, careful discussion between the patient and surgeon is necessary before surgery to ensure realistic expectations.
机译：背景：治疗关节软骨缺损和半月板缺乏症具有挑战性。尽管一些短期至中期的随访研究报告了同时进行自体软骨细胞移植（ACI）和半月板同种异体移植（MAT）后的良好临床结果，但仍需要更长的随访时间。目的：评估ACI与MAT合并后的中长期疗效。研究设计：案例系列;证据级别，第4级。方法：我们对来自1999年至2013年接受MAT的ACI的患者的前瞻性收集数据进行了回顾性回顾。一位外科医生对18例有半月板缺乏症状性全厚度软骨缺损患者进行了治疗。一名患者失访。因此，在平均7.9年的随访（2-16年）中评估了17例患者（18膝;平均年龄31.7岁）。平均每个膝盖的总表面积为7.6 cm〜（2）（范围为2.3-21 cm〜（2）），平均每个膝盖有1.8个病变。进行了17次外侧MAT和1次内侧MAT。使用Kaplan-Meier方法分析生存率。修改后的辛辛那提膝关节评定量表，西安大略省和麦克马斯特大学的骨关节炎指数，视觉模拟量表和Short-36模型用于评估临床结果。患者还自我报告了膝盖的功能和满意度。对标准的X射线照片评分为Kellgren-Lawrence（K-L）级。结果：5年和10年生存率均为75％。 6膝的结果被认为是失败的。在这6例失败的手术中，有4膝进行了置换术，另外2膝进行了生物翻修手术。在成功手术的12个膝盖中，所有临床措施均在术后显着改善。代表12膝中的11膝的十名患者将其膝关节结局评定为良好或优异，将1膝关节结局评定为正常。代表12个膝盖中的9个的8名患者对该手术感到满意。从术前至术后平均5.9年，基于K-L分级的骨关节炎无明显进展。 12个膝盖中有7个（58％）需要随后的手术程序（仅5个关节镜，2个关节镜和开放式膝关节镜）。结论：在中长期随访中，ACI与MAT结合可显着改善65％的手术膝盖。该程序可以使患者保留其膝盖的生物学特性，延迟或防止其迅速退化为骨关节炎，并且可以被认为是在人工膝关节置换之前的桥接程序。但是，在手术前，有必要在患者和外科医生之间进行仔细讨论，以确保切合实际。

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