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首页> 外文期刊>Osteoarthritis and cartilage >Classification of graft hypertrophy after autologous chondrocyte implantation of full-thickness chondral defects in the knee.
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Classification of graft hypertrophy after autologous chondrocyte implantation of full-thickness chondral defects in the knee.

机译：自体软骨细胞植入膝盖全层软骨缺损后的移植物肥大分类。

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OBJECTIVE: Graft hypertrophy is a major complication seen in autologous chondrocyte implantation (ACI) with a periosteal flap. We present the first magnetic resonance imaging (MRI) classification for periosteal hypertrophy including a grading of clinical symptoms and the surgical consequences. METHODS: One hundred and two patients with isolated chondral defects underwent an ACI covered with periosteum and were evaluated preoperatively, 6, 18 and 36 months after surgery. Exclusion criteria were meniscal pathologies, axial malpositioning and ligament instabilities. Baseline clinical scores were compared with follow-up data by paired Wilcoxon-tests for the modified Cincinnati knee, the ICRS (International Cartilage Repair Society) and a new MRI score including the parameters defect filling, subchondral edema, effusion, cartilage signal and graft hypertrophy. Hypertrophic changes were graded from 1 (minimal) to 4 (severe). RESULTS: All scores showed significant improvement (P<0.001) over the entire study period. Patients with femoral lesions had significantly better results than patients with patella lesions after 18 and 36 months postoperative (P<0.03). Periosteal hypertrophy occurred in 28% of all patients. Fifty percent of all patella implants developed hypertrophic changes. No patient with grade 1, and all patients with grade 4 hypertrophy had to undergo revision surgery. The Pearson correlation between graft hypertrophy and ICRS score was 0.78 after 6 months, and 0.69 after 36 months (P<0.01). Inclusion of graft hypertrophy in the MRI score improves the correlation to clinical scores from 0.6 to 0.69. CONCLUSIONS: Grading graft hypertrophy helps to identify patients needing an early shaving of the graft. Its integration into an MRI score improves correlation with clinical scores. Re-operation depends on the grade of hypertrophy and clinical symptoms.
机译：目的：移植物肥大是自体软骨细胞皮膜移植（ACI）所见的主要并发症。我们提出了骨膜肥大的第一个磁共振成像（MRI）分类，包括临床症状和手术后果的分级。方法：102例患有孤立性软骨缺损的患者接受了覆盖骨膜的ACI，并在术前，术后6、18和36个月进行了评估。排除标准为半月板病变，轴向错位和韧带不稳定性。通过成对的辛辛那提膝关节，ICRS（国际软骨修复协会）和新的MRI评分（包括缺陷填补，软骨下水肿，积液，软骨信号和移植物肥大等参数）的成对Wilcoxon测试，将基线临床评分与随访数据进行比较。肥大性变化的评分从1（最小）到4（严重）。结果：在整个研究期间，所有分数均显示出显着改善（P <0.001）。股骨病变患者在术后18和36个月后的结果明显优于than骨病变患者（P <0.03）。骨膜肥大发生在所有患者中的28％。所有骨植入物中有50％发生了肥大性变化。没有1级患者，所有4级肥大患者都必须接受翻修手术。移植物肥大与ICRS评分之间的Pearson相关性在6个月后为0.78，在36个月后为0.69（P <0.01）。 MRI评分中包含移植物肥大可将与临床评分的相关性从0.6改善至0.69。结论：对移植物肥大分级有助于确定需要尽早刮除移植物的患者。将其集成到MRI评分中可改善与临床评分的相关性。再次手术取决于肥大的等级和临床症状。

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