Department of Orthopedic Surgery and Anatomy & Cell Biology, Section Head, Rush Cartilage Restoration Center, Rush University Medical Center, 1725 West Harrison Street, Chicago, IL 60612, USA.
Am J Sports Med. 2009 Nov;37 Suppl 1:33S-41S. doi: 10.1177/0363546509349605. Epub 2009 Oct 27.
Reported results of autologous chondrocyte implantation for chondral lesions in the patellofemoral joint have been encouraging when combined with realignment procedures.
The objective of this study was to examine the clinical results of a patient cohort undergoing autologous chondrocyte implantation of the patellofemoral joint and elucidate characteristics associated with successful implantation.
Case series; Level of evidence, 4.
The cohort included 62 patients who underwent autologous chondrocyte implantation of the PF joint. The mean defect size was 4.2 cm(2) (+/-1.6). The average age was 31.8 years (range, 15.8-49.4), and the average follow-up was 4 years (range, 2-7). Outcomes were assessed via clinical assessment and established outcome scales, including the Lysholm, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Scale (KOOS; includes the 5 categories of Pain, Symptoms, Activities of Daily Living, Sport, and Quality of Life), Tegner, Cincinnati, and Short Form-12.
Mean improvement in the preoperative to postoperative scores was significant for the Lysholm (37-63, P <.001), International Knee Documentation Committee (31-57, P <.001), KOOS Pain (48-71, P <.001), KOOS Symptoms (51-70, P <.001), KOOS Activities of Daily Living (60-80, P <.001), KOOS Sport (25-42, P <.001), KOOS Quality of Life (24-49, P <.001), Short Form-12 Physical (38-41, P <.05), Cincinnati (43-63, P <.005), and Tegner (4-6, P <.05), but not for the Short Form-12 Mental. There was no statistical difference between outcomes in patients with a history of a previous failed cartilage procedure compared with those patients without a prior cartilage procedure (P > .05). Patients undergoing anteromedialization tended toward better outcomes than those without realignment. Forty-four percent of patients needed a subsequent procedure. There were 4 clinical failures (7.7%), which were defined as progression to arthroplasty or conversion to osteochondral allograft transplantation.
Autologous chondrocyte implantation is a viable treatment option for chondral defects of the patellofemoral joint. Combined autologous chondrocyte implantation with anteromedialization improves outcomes more than autologous chondrocyte implantation alone. Patients with failed prior cartilage procedures can also expect sustained and clinically meaningful improvement.
当与重新排列程序结合使用时，自体软骨细胞移植治疗髌股关节软骨损伤的结果令人鼓舞。
本研究的目的是检查接受髌股关节自体软骨细胞移植的患者队列的临床结果，并阐明与成功植入相关的特征。
病例系列；证据水平，4 级。
该队列包括 62 名接受髌股关节自体软骨细胞移植的患者。平均缺损大小为 4.2cm²（+/-1.6）。平均年龄为 31.8 岁（范围，15.8-49.4），平均随访时间为 4 年（范围，2-7）。通过临床评估和既定的结果量表评估结果，包括 Lysholm、国际膝关节文献委员会、膝关节损伤和骨关节炎结果量表（KOOS；包括疼痛、症状、日常生活活动、运动和生活质量 5 个类别）、Tegner、辛辛那提和 12 项简短表格。
术前至术后评分的平均改善在 Lysholm（37-63，P<.001）、国际膝关节文献委员会（31-57，P<.001）、KOOS 疼痛（48-71，P<.001）、KOOS 症状（51-70，P<.001）、KOOS 日常生活活动（60-80，P<.001）、KOOS 运动（25-42，P<.001）、KOOS 生活质量（24-49，P<.001）、简短表格-12 物理（38-41，P<.05）、辛辛那提（43-63，P<.005）和 Tegner（4-6，P<.05）方面具有统计学意义，但简短表格-12 心理方面没有统计学意义。与没有先前软骨手术史的患者相比，有先前软骨手术失败史的患者的结果之间没有统计学差异（P>.05）。接受前内侧化的患者的结果好于没有进行重新排列的患者。44%的患者需要进行后续手术。有 4 例临床失败（7.7%），定义为进展为关节置换或转换为骨软骨同种异体移植。
自体软骨细胞移植是治疗髌股关节软骨缺损的可行治疗选择。与单独自体软骨细胞移植相比，联合前内侧化可改善结果。先前有软骨手术失败的患者也可以预期持续和具有临床意义的改善。
