Kuroki Hiroshi, Nakagawa Yasuaki, Mori Koji, Kobayashi Masahiko, Okamoto Yukihiro, Yasura Ko, Nishitani Kohei, Nakamura Takashi
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Arthroscopy. 2007 Jun;23(6):647-54. doi: 10.1016/j.arthro.2007.01.012.
For successful autologous osteochondral transplantation, it is important that the cartilage in an implanted plug provide histologic replacement of damaged cartilage with cartilage that is structurally and mechanically normal. The purpose of this study was to investigate whether the press-fit technique reconstructs the normal hyaline cartilage and provides acoustic stiffness equal to that of normal intact cartilage.
In 36 rabbits an osteochondral plug, 6 mm in diameter, was removed from the right patellar groove and grafted into a recipient hole, 5 mm in diameter, in the left patellar groove. Specimens at 2, 4, 8, 12, 24, and 52 weeks postoperatively were assessed by macroscopic and histologic observation and by use of an ultrasonic system. The ultrasonic acoustic stiffness, acoustic surface irregularity, and acoustic thickness of the implanted cartilage were examined and compared with normal intact cartilage.
The gross appearance of the implanted cartilage was glossy, maintained good surface smoothness, and survived well throughout the observation period. The cartilage recovered histologic features of hyaline cartilage. The acoustic stiffness decreased up to 12 weeks and then increased at 24 and 52 weeks after surgery. The acoustic stiffness at 8 or 12 weeks was significantly lower (acoustically softer) than that of control cartilage (P < .001). The acoustic stiffness at 52 weeks was equal to that of the control. The difference in acoustic surface irregularity was not significant. The acoustic thickness at 8 weeks was higher (acoustically thicker) than that of the control (P < .01).
Although the reason acoustically soft cartilage in plugs becomes acoustically stiff and whether the histology of the implanted cartilage had recovered completely remain unclear, the acoustic stiffness recovered to normal control values by 52 weeks postoperatively.
Postoperative care for up to 12 weeks should be taken after autologous osteochondral transplantation.
为成功进行自体骨软骨移植，植入栓体中的软骨能够以结构和力学性能正常的软骨对受损软骨进行组织学替代至关重要。本研究的目的是调查压配技术是否能重建正常透明软骨并提供与正常完整软骨相等的声学硬度。
在36只兔子中，从右髌沟取出直径6毫米的骨软骨栓体，植入左髌沟中直径5毫米的受体孔内。术后2周、4周、8周、12周、24周和52周的标本通过宏观和组织学观察以及使用超声系统进行评估。检查植入软骨的超声声学硬度、声学表面不规则性和声学厚度，并与正常完整软骨进行比较。
植入软骨的大体外观有光泽，保持良好的表面光滑度，并且在整个观察期内存活良好。软骨恢复了透明软骨的组织学特征。声学硬度在术后12周时下降，然后在24周和52周时增加。8周或12周时的声学硬度明显低于对照软骨（声学上更软）（P <.001）。52周时的声学硬度与对照相等。声学表面不规则性的差异不显著。8周时的声学厚度高于对照（声学上更厚）（P <.01）。
虽然栓体中声学软的软骨变得声学硬的原因以及植入软骨的组织学是否已完全恢复尚不清楚，但声学硬度在术后52周时恢复到正常对照值。
自体骨软骨移植后应进行长达12周的术后护理。
