Takahashi Tomoki, Tins Bernhard, McCall Iain W, Richardson James B, Takagi Katsumasa, Ashton Karen
Department of Radiology & Institute of Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, Shropshire, UK.
Skeletal Radiol. 2006 Jan;35(1):16-26. doi: 10.1007/s00256-005-0002-3. Epub 2005 Nov 12.
To relate the magnetic resonance imaging (MRI) appearance of autologous chondrocyte implantation (ACI) in the knee in the 1st postoperative year with other knee features on MRI and with clinical outcome.
Forty-nine examinations were performed in 49 patients at 1 year after ACI in the knee. Forty-one preoperative magnetic resonance (MR) examinations were also available. The grafts were assessed for smoothness, thickness in comparison with that of adjacent cartilage, signal intensity, integration to underlying bone and adjacent cartilage, and congruity of subchondral bone. Presence of overgrowth and bone marrow appearance beneath the graft were also assessed. Presence of osteophyte formation, further cartilage defects, appearance of the cruciate ligaments and the menisci were also recorded. An overall graft score was constructed, using the graft appearances. This was correlated with the knee features and the Lysholm score, a clinical self-assessment score. The data were analysed by a Kruskal-Wallis H test followed by a Mann-Whitney U test with Bonferroni correction as post-hoc test.
Of 49 grafts, 32 (65%) demonstrated complete defect filling 1 year postoperatively. General overgrowth was seen in eight grafts (16%), and partial overgrowth in 13 grafts (26%). Bone marrow change underneath the graft was seen; oedema was seen in 23 grafts (47%), cysts in six grafts (12%) and sclerosis in two grafts (4%). Mean graft score was 8.7 (of maximal 12) (95% CI 8.0-9.5). Knees without osteophyte formation or additional other cartilage defects (other than the graft site) had a significantly higher graft score than knees with multiple osteophytes (P=0.0057) or multiple further cartilage defects (P=0.014). At 1 year follow-up improvement in the clinical scores was not significantly different for any subgroup. Knees with a graft score of 8 points or greater had a better improvement of the clinical score than those of 7 points or fewer.
At 1 year follow-up after ACI, higher graft scores are associated with an overall better preserved knee joint. ACI improves the clinical outcome, but there is no statistically significant correlation of graft score and clinical outcome.
将膝关节自体软骨细胞移植（ACI）术后第1年的磁共振成像（MRI）表现与MRI上的其他膝关节特征及临床结果相关联。
对49例膝关节行ACI术后1年的患者进行了49次检查。同时也有41例术前磁共振（MR）检查资料。评估移植物的光滑度、与相邻软骨相比的厚度、信号强度、与下方骨及相邻软骨的整合情况、软骨下骨的一致性。还评估移植物下方是否有过度生长及骨髓表现。记录是否有骨赘形成、进一步的软骨缺损、交叉韧带和半月板的情况。根据移植物表现构建总体移植物评分。将其与膝关节特征及Lysholm评分（一种临床自我评估评分）相关联。数据采用Kruskal-Wallis H检验，随后采用Mann-Whitney U检验并进行Bonferroni校正作为事后检验进行分析。
49个移植物中，32个（65%）在术后1年显示完全填充缺损。8个移植物（16%）出现普遍过度生长，13个移植物（26%）出现部分过度生长。观察到移植物下方的骨髓改变；23个移植物（47%）出现水肿，6个移植物（12%）出现囊肿，2个移植物（4%）出现硬化。移植物平均评分为8.7（满分12分）（95%可信区间8.0 - 9.5）。无骨赘形成或其他额外软骨缺损（除移植物部位外）的膝关节移植物评分显著高于有多个骨赘（P = 0.0057）或多个其他软骨缺损（P = 0.014）的膝关节。在1年随访时，任何亚组的临床评分改善均无显著差异。移植物评分为8分或更高的膝关节临床评分改善优于7分或更低的膝关节。
ACI术后1年随访时，较高的移植物评分与膝关节整体保存较好相关。ACI改善了临床结果，但移植物评分与临床结果无统计学显著相关性。
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