Rose Tim, Craatz Steffen, Hepp Pierre, Raczynski Conrad, Weiss Joachim, Josten Christoph, Lill Helmut
Department for Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany.
Arch Orthop Trauma Surg. 2005 Nov;125(9):628-37. doi: 10.1007/s00402-005-0010-8.
The osteochondral transplantation (OCT) is a well accepted treatment option for focal cartilage lesions in the knee joint, whereas the fate of the transplanted cartilage is still unclear and the clinical outcome is variable. The purpose of this study was to evaluate the histological character of autologous transplanted cartilage and to correlate technical aspects and the patients' history with the clinical outcome.
The OCT was performed in 27 patients (median age of 32 (22-43) years) with a focal chondral lesion at the medial femoral condyle. We investigated the clinical outcome after a median follow-up of 13.5 (5-28) months using the Lysholm-score and the integration of the transplanted plugs using an MRI-scoring system. Biopsy specimens from representative patients (n = 8) were evaluated with histological staining and immunohistochemistry.
The median Lysholm-score was 80 (range 45-98). The wide range of the Lysholm-score in clinical outcome did not show significant differences in: follow-up, concomitant injuries, defect size or genesis. The MRI analysis revealed in all cases a regular osseous integration of the subchondral bone, but a failed chondral integration. The congruency of the plugs to the joint surface was often incorrect, however a correlation between the MRI-score and the clinical outcome could not be shown. Histology of the transplanted cartilage revealed small changes in immunohistochemistry after a relatively short-term follow-up, whereas the cartilage has still the typical hyaline character. Often, the surrounding cartilage consists of fibrous and granulation tissue.
The congruency of the joint surface can not be restored to the original status, particularly in larger defects with irregular shapes. However, we did not find any aspects which affected the function of the knee joint following OCT. It can be assumed that remaining lesions at the surrounding cartilage could maintain the inflammatory process and therefore maintain the pain and a low knee function. Further investigations are needed to specify the effects of the OCT on the transplanted cartilage and its influence on the later clinical outcome.
骨软骨移植（OCT）是膝关节局灶性软骨损伤一种广泛接受的治疗选择，然而，移植软骨的命运仍不明确，临床结果也存在差异。本研究的目的是评估自体移植软骨的组织学特征，并将技术方面和患者病史与临床结果相关联。
对27例（中位年龄32（22 - 43）岁）股骨内侧髁局灶性软骨损伤患者进行了骨软骨移植。我们使用Lysholm评分和MRI评分系统对移植栓的整合情况进行评估，在中位随访13.5（5 - 28）个月后调查临床结果。对代表性患者（n = 8）的活检标本进行组织学染色和免疫组织化学评估。
Lysholm评分中位数为80（范围45 - 98）。临床结果中Lysholm评分的广泛范围在以下方面未显示出显著差异：随访、合并损伤、缺损大小或病因。MRI分析在所有病例中均显示软骨下骨有规则的骨整合，但软骨整合失败。移植栓与关节面的一致性通常不正确，然而，未显示出MRI评分与临床结果之间的相关性。移植软骨的组织学显示，在相对短期随访后免疫组织化学有微小变化，而软骨仍具有典型的透明软骨特征。通常，周围软骨由纤维组织和肉芽组织组成。
关节面的一致性无法恢复到原始状态，特别是在形状不规则的较大缺损中。然而，我们未发现任何影响骨软骨移植后膝关节功能的因素。可以假设，周围软骨的残留病变可能维持炎症过程，从而维持疼痛和膝关节功能低下。需要进一步研究以明确骨软骨移植对移植软骨的影响及其对后期临床结果的影响。
