Orljanski W, Aghayev E, Zazirnyj I, Schabus R
Department of Sport Traumatology, Vienna, Austria.
Acta Chir Orthop Traumatol Cech. 2005;72(4):246-9.
A chondral/osteochondral defect involving the articular surface of a joint is still a therapeutic problem. Many surgical techniques have been studied in an attempt to restore the damaged articular cartilage. Autogenous osteochondral graft has gained in clinical popularity because of its technical feasibility and cost effectiveness, however, only a few series have been reported in the literature.
A retrospective study included 14 patients with 14 knees with focal full thickness articular cartilage defects hospitalised in our department between January 1997 and June 2000. The diagnoses included six knees with osteonecrosis, five knees with osteochondritis dissecans and three knees with traumatic cartilage defect.
All these patients underwent an osteochondral autografts of the knee with 2 years follow-up. The evaluations were based on functional assessments, which included pain, giving way, locking, recurrent effusion, knee scores, functional scores and Lysholm scores. The postoperative values of functional assessments among the three categories of diagnosis were compared statistically using Kruskal-Wallis test. Radiographs of the knees were examined for joint congruence, joint space narrowing and degenerative changes.
The study showed good or excellent clinical results in over than 85%. The duration of pain of the knees relief ranged from six to 16 weeks after surgery.
There was no correlation of the clinical results with the underlying diagnosis, including osteonecrosis, osteochondritis dissecans and traumatic cartilage defect. Improvement in symptoms appeared time-dependent, ranging from 6 to 16 weeks, suggesting that postoperative protection of the graft is warranted. There was no radiographic progression of degenerative changes of the knee on the medium-term follow-up.
There was no correlation of the clinical results with the underlying diagnoses. It appears that an osteochondral graft has the potential to prevent or delay the development of degenerative changes of the knee in the medium-term follow-up. Autogenous osteochondral graft is considered as a good method in the treatment of knees with moderately sized articular cartilage defects.
涉及关节面的软骨/骨软骨缺损仍然是一个治疗难题。人们研究了许多手术技术，试图修复受损的关节软骨。自体骨软骨移植因其技术可行性和成本效益在临床上越来越受欢迎，然而，文献中报道的病例系列较少。
一项回顾性研究纳入了1997年1月至2000年6月期间在我科住院的14例患者的14个膝关节，这些膝关节存在局灶性全层关节软骨缺损。诊断包括6个膝关节骨坏死、5个膝关节剥脱性骨软骨炎和3个膝关节创伤性软骨缺损。
所有这些患者均接受了膝关节自体骨软骨移植，并进行了2年的随访。评估基于功能评价，包括疼痛、打软腿、交锁、反复积液、膝关节评分、功能评分和Lysholm评分。使用Kruskal-Wallis检验对三类诊断的功能评价术后值进行统计学比较。检查膝关节X线片以评估关节一致性、关节间隙变窄和退变改变。
研究显示超过85%的患者临床结果良好或优秀。膝关节疼痛缓解的持续时间为术后6至16周。
临床结果与潜在诊断（包括骨坏死、剥脱性骨软骨炎和创伤性软骨缺损）无关。症状改善呈时间依赖性，为6至16周，这表明术后对移植物进行保护是必要的。中期随访时膝关节退变改变无影像学进展。
临床结果与潜在诊断无关。在中期随访中，自体骨软骨移植似乎有可能预防或延缓膝关节退变改变的发展。自体骨软骨移植被认为是治疗中等大小关节软骨缺损膝关节的一种好方法。
