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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Retroarticular Drilling with Supplemental Bone Marrow Aspirate Concentrate for the Treatment of Osteochondritis Dissecans of the Knee
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Retroarticular Drilling with Supplemental Bone Marrow Aspirate Concentrate for the Treatment of Osteochondritis Dissecans of the Knee

机译：关节后钻孔补充骨髓抽吸浓缩液治疗膝关节骨软骨炎

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Objectives: Osteochondritis dissecans (OCD) is an idiopathic alteration of the subchondral bone which may lead to early osteoarthritis. This condition is commonly seen in the knee and is more common in young, athletic individuals. Several techniques have been developed to address the variable presentation of OCD in the knee, each with varying results. To our knowledge the use of autogenous bone marrow supplementation to an OCD lesion has not been described. The purpose of this study was to determine the radiographic healing of OCD lesions of the knee in a cohort of young, active patients who underwent retroarticular drilling of an OCD lesion with supplemental back-filling with bone marrow aspirate concentrate as an adjuvant to facilitate healing. Methods: We evaluated adolescent patients who were diagnosed with OCD of the knee who had previously failed non-operative, conservative treatment. All subjects underwent retroarticular drilling of the knee with supplemental back-filling of the lesion with bone marrow aspirate concentrate (BMAC?), harvested from the ilium, by two Orthopaedic Surgeons from a single institution. Based off previously published definitions, lesions were assigned as small if < 320 mm~(2)or large >320 mm~(2). All lesions were then followed radiographically for evidence of healing. Healing was graded based off the ROCK (Research in OsteoChondritis of the Knee) group radiographic healing criteria, which has shown excellent reliability. The healing was rated by two independent reviewers and when disagreements were noted a third reviewer was brought in to facilitate group consensus on healing. Results: 52 lesions in 49 patients were included in the study. 26 right knees, 26 left knees with 41 lesions located on the medial femoral condyle and 11 lesions located on the lateral femoral condyle. The mean age of the subjects was 12.5 (10 - 17) years old. 30 subjects were male, 19 were female. All lesions were categorized as immobile lesions based off the ROCK Arthroscopy Classification. The average OCD lesion size was 407 mm~(2)(132 - 899 mm~(2)), respectively. The mean amount of BMAC? used per OCD lesion was 60 mL (45 - 120 mL). 40 lesions (76.9%) were rated as healed at a mean of 10.6 (2 - 32) months. 10 lesions (18.9%) were rated as 25-75% healed and 3.8% were rated at 0 - 25% healed at latest follow-up. 76.5% of large lesions were rated as healed at final follow-up. Whereas 77.8% of small lesions were rated as healed at final follow-up. There were three complications (1 rash from skin glue, 1 suture abscess, and 1 contact dermatitis from surgical cleansing prep) however no complications were noted from the surgical intervention or BMAC?. Conclusion: Overall healing rates with surgical treatment of OCD lesions that have failed non-operative interventions are variable. For immobile lesions, mainstay treatment options include retroarticular and transarticular drilling. Based off previous definitions of lesion size, the mean lesion size in our cohort would be categorized as “large” with 65% of our lesions falling into this category. Previously published series have shown that large lesions are significantly less likely to heal. Despite this we showed a 76.5% healing rate for large lesions. Overall, the adjuvant supplementation of BMAC? as back-fill for retrograde drilling of large OCD lesions of the knee has shown excellent results with no serious complications associated with its use. Future randomized trials are necessary to evaluate the comparative effectiveness of this treatment method.
机译：目的：解剖性骨软骨炎（OCD）是软骨下骨的特发性改变，可能导致早期骨关节炎。这种情况常见于膝盖，在年轻的运动个体中更常见。已经开发出多种技术来解决OCD在膝盖中的变化表现，每种技术都有不同的结果。就我们所知，尚未描述使用自体骨髓补充剂来治疗OCD病变。这项研究的目的是确定一群年轻，活跃的患者的膝关节OCD损伤的影像学愈合，这些患者接受了OCD病变的后关节钻孔，并辅以骨髓抽吸浓缩液作为辅助剂来促进愈合。方法：我们评估了以前被诊断为非手术，保守治疗失败的膝关节OCD的青少年患者。所有受试者均接受膝关节的后关节钻孔，并由来自同一机构的两名整形外科医生用the骨采集的骨髓抽吸浓缩液（BMAC？）进行病灶的补充回充。根据先前发布的定义，如果<320 mm〜（2），则将病变分配为小;如果> 320 mm〜（2），则将病变分配为大。然后对所有病变进行影像学检查以寻找治愈的证据。根据ROCK（膝骨骨软骨炎研究）组的放射线愈合标准对愈合进行了分级，已显示出极好的可靠性。由两名独立的审阅者对愈合进行评估，当发现分歧时，请第三名审阅者参加，以促进小组就愈合达成共识。结果：49名患者中的52个病变被纳入研究。右膝26个，左膝26个，其中41个位于股骨media内侧病变，11个位于股骨外侧lateral病变。受试者的平均年龄为12.5（10-17）岁。男性30名，女性19名。根据ROCK关节镜分类将所有病变归为固定性病变。平均OCD病变大小分别为407 mm〜（2）（132-899 mm〜（2））。 BMAC的平均数量？每个OCD病变使用的剂量为60 mL（45-120 mL）。平均有10.6（2-32）个月的时间治愈了40个病变（76.9％）。在最近的随访中，有10个病变（占18.9％）被治愈率为25-75％，有3.8％被治愈为0-25％。在最后的随访中，有76.5％的大病灶被治愈。而在最后的随访中，有77.8％的小病变被治愈。共有3种并发症（1例因皮胶引起的皮疹，1例缝合脓肿，1例由于手术清洁准备而引起的接触性皮炎），但手术干预或BMAC？均未发现并发症。结论：非手术干预失败的强迫症手术治疗的总体治愈率是可变的。对于不动的病变，主要的治疗选择包括关节后钻孔和经关节钻孔。根据先前对病变大小的定义，我们队列中的平均病变大小将被归类为“大”，其中65％的病变属于此类别。先前发表的系列文章表明，大的病变愈合的可能性明显较小。尽管如此，我们显示出大病变的治愈率为76.5％。总体而言，BMAC的辅助补充剂是什么？由于回填可用于大面积OCD膝关节逆行钻探，因此显示了极好的效果，并且没有与使用相关的严重并发症。未来的随机试验对于评估这种治疗方法的相对有效性是必要的。

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