Gobbi Alberto, Kon Elizaveta, Berruto Massimo, Filardo Giuseppe, Delcogliano Marco, Boldrini Lorenzo, Bathan Lyndon, Marcacci Maurilio
Orthopaedic Arthroscopic Surgery International Bioresearch Foundation, 24 Via Amadeo GA, Milan 20133, Italy.
Am J Sports Med. 2009 Jun;37(6):1083-92. doi: 10.1177/0363546509331419.
Patellofemoral lesions represent a very troublesome condition to treat for orthopaedic surgeons; however, second-generation autologous chondrocyte implantation (ACI) seems to offer an interesting treatment option with satisfactory results at short-term follow-up.
Hyaluronan-based scaffold seeded with autologous chondrocytes is a viable treatment for the damaged articular surface of the patellofemoral joint.
Case series; Level of evidence, 4.
Among a group of 38 patients treated for full-thickness patellofemoral chondral lesions with second-generation ACI, we investigated 34 who were available for final follow-up at 5 years. These 34 had chondral lesions with a mean size of 4.45 cm(2). Twenty-one lesions were located on the patella, 9 on the trochlea, and 4 patients had multiple lesions: 3 had patellar and trochlear lesions, and 1 had patellar and lateral femoral condyle lesions. Twenty-six lesions (76.47%) were classified as International Cartilage Repair Society (ICRS) grade IV A or B, 5 lesions (14.70%) were grade IIIC, and 3 (8.82%) were lesions secondary to osteochondritis dissecans (OCD). Results were evaluated using the International Knee Documentation Committee (IKDC) 2000 subjective and objective scores, EuroQol (EQ) visual analog scale (VAS), and Tegner scores at 2 and 5 years. Eight patients had second-look arthroscopy and biopsies.
All the scores used demonstrated a statistically significant improvement (P < .0005) at 2 and 5 years' follow-up. Objective preoperative data improved from 8 of 34 (23.52%) normal or nearly normal knees to 32 of 34 (94.12%) at 2 years and 31 of 34 (91.17%) at 5 years after transplantation. Mean subjective scores improved from 46.09 points preoperatively to 77.06 points 2 years after implantation and 70.39 at 5 years. The Tegner score improved from 2.56 to 4.94 and 4.68, and the EQ VAS improved from 56.76 to 81.47 and 78.23 at 2 and 5 years' follow-up, respectively. A significant decline of IKDC subjective and Tegner scores was found in patients with multiple and patellar lesions from 2 to 5 years' follow-up. Second-look arthroscopies in 8 cases revealed the repaired surface to be nearly normal with biopsy samples characterized as hyaline-like in appearance.
Hyaluronan-based scaffold seeded with autologous chondrocytes can be a viable treatment for patellofemoral chondral lesions.
髌股关节损伤对于骨科医生而言是一种极难治疗的病症；然而，第二代自体软骨细胞移植（ACI）似乎提供了一种有趣的治疗选择，在短期随访中取得了令人满意的效果。
接种自体软骨细胞的透明质酸基支架是治疗髌股关节受损关节面的一种可行方法。
病例系列；证据等级，4级。
在一组38例接受第二代ACI治疗全层髌股软骨损伤的患者中，我们对34例在5年时可进行最终随访的患者进行了调查。这34例患者的软骨损伤平均大小为4.45平方厘米。21处损伤位于髌骨，9处位于滑车，4例患者有多处损伤：3例有髌骨和滑车损伤，1例有髌骨和股骨外侧髁损伤。26处损伤（76.47%）被归类为国际软骨修复协会（ICRS）IV A或B级，5处损伤（14.70%）为IIIC级，3处（8.82%）为剥脱性骨软骨炎（OCD）继发损伤。在2年和5年时，使用国际膝关节文献委员会（IKDC）2000主观和客观评分、欧洲五维度健康量表（EQ）视觉模拟量表（VAS）以及Tegner评分对结果进行评估。8例患者接受了二次关节镜检查和活检。
在2年和5年的随访中，所有使用的评分均显示出统计学上的显著改善（P <.0005）。术前客观数据显示，34例患者中8例（23.52%）膝关节正常或接近正常，移植后2年时改善至34例中的32例（94.12%），5年时为34例中的31例（91.17%）。平均主观评分从术前的46.09分提高到植入后2年的77.06分和5年时的70.39分。Tegner评分在2年和5年随访时分别从2.56提高到4.94和4.68，EQ VAS从56.76提高到81.47和78.23。在2至5年的随访中，发现多处损伤和髌骨损伤患者的IKDC主观评分和Tegner评分显著下降。8例患者的二次关节镜检查显示修复表面接近正常，活检样本外观为透明软骨样。
接种自体软骨细胞的透明质酸基支架可作为治疗髌股软骨损伤的一种可行方法。
