Nho Shane J, Foo Li Foong, Green David M, Shindle Michael K, Warren Russell F, Wickiewicz Thomas L, Potter Hollis G, Williams Riley J
Institute for Cartilage Repair, The Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, USA.
Am J Sports Med. 2008 Jun;36(6):1101-9. doi: 10.1177/036354650831441. Epub 2008 Mar 12.
Autologous osteochondral transplantation (AOT) has been successfully used in the femoral condyle and trochlea and is an attractive treatment option for full-thickness patellar cartilage lesions.
Patients treated with AOT for the repair of symptomatic, isolated patellar cartilage lesions will demonstrate improvement in functional outcomes and postoperative magnetic resonance imaging appearance.
Case series; Level of evidence, 4.
Between 2002 and 2006, patients with focal patellar cartilage lesions treated with AOT were prospectively followed. The mean age at the time of surgery was 30 years. Clinical assessment was performed with the International Knee Documentation Committee (IKDC), activities of daily living of the Knee Outcome Survey (ADL), and Short Form-36 (SF-36) at baseline and most recent follow-up. Magnetic resonance imaging was used to evaluate the cartilage repair morphologic characteristics in 14 cases.
Twenty-two patients met the study criteria with a mean follow-up of 28.7 months (range, 17.7-57.8 months). The mean patellar lesion size was 165.6 +/- 127.8 mm(2), and the mean size of the donor plug was 9.7 +/- 1.1 mm in diameter with 1.8 +/- 1.4 plugs/defect. The mean preoperative IKDC score was 47.2 +/- 14.0 and improved to 74.4 +/- 12.3 (P = .028). The mean preoperative ADL score was 60.1 +/- 16.9 and increased to 84.7 +/- 8.3 (P = .022). The mean SF-36 also demonstrated an improvement, from 64.0 +/- 14.8 at baseline to 79.4 +/- 15.4 (P = .059). Nine patients underwent concomitant distal realignment and demonstrated improvement between preoperative and postoperative outcomes scores, but these differences were not statistically significant. Magnetic resonance imaging appearance demonstrated that all plugs demonstrated good (67%-100%) cartilage fill, 64% with fissures < 2 mm at the articular cartilage interface, 71% with complete trabecular incorporation, and 71% with flush plug appearance.
Patellar AOT is an effective treatment for focal patellar chondral lesions, with significant improvement in clinical follow-up. This study suggests that patients with patellar malalignment may represent a subset of patients who have a poor prognostic outlook compared with patients with normal alignment.
自体骨软骨移植（AOT）已成功应用于股骨髁和滑车，是治疗全层髌软骨损伤的一种有吸引力的选择。
接受AOT治疗有症状的孤立性髌软骨损伤的患者，其功能结果和术后磁共振成像表现将得到改善。
病例系列；证据级别，4级。
2002年至2006年，对接受AOT治疗的局灶性髌软骨损伤患者进行前瞻性随访。手术时的平均年龄为30岁。在基线和最近一次随访时，采用国际膝关节文献委员会（IKDC）、膝关节功能结果调查日常生活活动能力（ADL）和简短健康调查问卷36项（SF-36）进行临床评估。使用磁共振成像评估14例患者的软骨修复形态学特征。
22例患者符合研究标准，平均随访28.7个月（范围17.7 - 57.8个月）。髌部损伤平均大小为165.6±127.8 mm²，供体移植物平均直径为9.7±1.1 mm，每个缺损平均使用1.8±1.4个移植物。术前IKDC平均评分为47.2±14.0，改善至74.4±12.3（P = .028）。术前ADL平均评分为60.1±16.9，增至84.7±8.3（P = .022）。SF-36平均评分也有所改善，从基线时的64.0±14.8提高至79.4±15.4（P = .059）。9例患者同时进行了远端对线调整，术前和术后结果评分均有改善，但这些差异无统计学意义。磁共振成像显示，所有移植物均有良好（67% - 100%）的软骨填充，64%在关节软骨界面处裂隙<2 mm，71%有完整的小梁整合，71%移植物外观平齐。
髌部AOT是治疗局灶性髌软骨损伤的有效方法，临床随访有显著改善。本研究表明，与对线正常的患者相比，髌部对线不良的患者可能是预后较差的一个亚组。
