Peterson Lars, Minas Tom, Brittberg Mats, Lindahl Anders
Institution for Orthopaedics, Gothenburg University, Sahlgrenska University Hospital, Sweden.
J Bone Joint Surg Am. 2003;85-A Suppl 2:17-24. doi: 10.2106/00004623-200300002-00003.
Osteochondritis dissecans of the knee is a challenging clinical problem. We previously reported on the early successful results of autologous chondrocyte transplantation for the treatment of focal cartilage defects. The purpose of the present study was to assess the intermediate to long-term results of this technique in a large group of patients with osteochondritis dissecans.
Fifty-eight patients with radiographically documented osteochondritis dissecans of the knee underwent treatment with autologous chondrocyte transplantation between 1987 and 2000 and were assessed clinically with use of standard rating scales. Twenty-two patients consented to arthroscopic second-look evaluation of graft integrity.
The mean age of the patients at the time of autologous chondrocyte transplantation was 26.4 years (range, fourteen to fifty-two years). Seven patients were less than eighteen years old. Thirty-five patients (60%) had juvenile-onset disease, and forty-eight patients (83%) had had a mean of 2.1 prior operations. The defect was located on the medial femoral condyle in thirty-nine patients and on the lateral femoral condyle in nineteen. The mean lesion size was 5.7 cm (2) (range, 1.5 to 12.0 cm (2) ), and the mean defect depth was 7.8 mm (range, 4 to 15 mm). After a mean duration of follow-up of 5.6 years, 91% of the patients had a good or excellent overall rating on the basis of a clinician evaluation and 93% had improvement on a patient self-assessment questionnaire. The Tegner-Wallgren, Lysholm, and Brittberg-Peterson VAS scores were all improved. The macroscopic quality of graft integrity averaged 11.2 on a 12-point scale, with only one graft having a score of <9 points. Two patients had a failure of treatment in the early postoperative period. Only one patient who had had a good or excellent rating at two years had a decline in clinical status at the time of the latest follow-up.
Treatment of osteochondritis dissecans lesions of the knee with autologous chondrocyte transplantation produces an integrated repair tissue with a successful clinical result in >90% of patients. We recommend the wider use of autologous chondrocyte transplantation for this condition.
膝关节剥脱性骨软骨炎是一个具有挑战性的临床问题。我们之前报道了自体软骨细胞移植治疗局限性软骨缺损的早期成功结果。本研究的目的是评估该技术在一大组膝关节剥脱性骨软骨炎患者中的中长期结果。
1987年至2000年间，58例经影像学证实的膝关节剥脱性骨软骨炎患者接受了自体软骨细胞移植治疗，并使用标准评分量表进行临床评估。22例患者同意接受关节镜二次检查以评估移植物完整性。
自体软骨细胞移植时患者的平均年龄为26.4岁（范围为14至52岁）。7例患者年龄小于18岁。35例患者（60%）为青少年发病，48例患者（83%）平均曾接受过2.1次先前手术。缺损位于股骨内侧髁39例，位于股骨外侧髁19例。平均病变大小为5.7平方厘米（范围为1.5至12.0平方厘米），平均缺损深度为7.8毫米（范围为4至15毫米）。平均随访5.6年后，根据临床医生评估，91%的患者总体评分良好或优秀，93%的患者在患者自我评估问卷上有改善。Tegner-Wallgren、Lysholm和Brittberg-Peterson视觉模拟评分均有所提高。移植物完整性的宏观质量在12分制量表上平均为11.2分，只有一个移植物得分<9分。2例患者在术后早期治疗失败。只有1例在两年时评分良好或优秀的患者在最近一次随访时临床状况下降。
用自体软骨细胞移植治疗膝关节剥脱性骨软骨炎病变可产生整合的修复组织，超过90%的患者临床结果成功。我们建议更广泛地使用自体软骨细胞移植治疗这种疾病。
