Gudas Rimtautas, Simonaityte Rasa, Cekanauskas Emilis, Tamosiūnas Ramūnas
Kaunas University of Medicine, Kaunas, Lithuania.
J Pediatr Orthop. 2009 Oct-Nov;29(7):741-8. doi: 10.1097/BPO.0b013e3181b8f6c7.
The aim of this study was to compare the outcomes of the arthroscopic mosaic-type osteochondral autologous transplantation (OAT) and microfracture (MF) procedures for the treatment of osteochondritis dissecans (OCD) defects of the femoral condyles of the knee joint in children under the age of 18 years.
Prospective, randomized clinical study.
Between 2001 and 2005, a total of 50 children with a mean age of 14.3 years (12 to 18) and with symptomatic lesions of the OCD in the femoral condyle of the knee were randomized to undergo either the OAT or the MF procedure. Only those children with grade 3 or 4 (OCD) in the medial or lateral femoral condyle (according to International Cartilage Repair Society, ICRS) were included in the study. Forty-seven patients (94%) were available for follow-up. There were 25 patients in the OAT group and 22 patients in the MF group. The mean duration of symptoms was 23.54+/-4.24 months and the mean follow-up was 4.2 years (range from 3 to 6 y), and none of the children had prior surgical interventions to the affected knee. Children were evaluated using ICRS score, x-rays, magnetic resonance imaging, and second-look arthroscopies.
After 1 year, both groups had significant clinical improvement (P<0.05) and the ICRS functional and objective assessment showed that 23 of 25 (92%) patients had excellent or good results after OAT compared with 19 of 22 (86%) after MF (NS), but 19 of 23 (83%) after OAT and only 12 of 19 (63%) after MF procedure maintained excellent or good results after 4.2 years (range from 3 to 6 y). The MF group showed significant deterioration over the 4.2 years follow-up (P<0.05), but still had significant clinical improvement compared with pretreatment evaluation (P=0.004). There were 9 of 22 (41%) failures in the MF group, and none in the OAT group. Magnetic resonance imaging evaluation according to the ICRS evaluation system showed excellent or good repairs in 19 of 21 patients (91%) after OAT compared with 10 of 18 (56%) after MF.
At an average of 4.2 years follow-up, our prospective, randomized, clinical study in children under the age of 18 years has shown significant superiority of the mosaic-type OAT over MF for the treatment of osteochondritis dissecans defects in the knee. However, our study has shown that both MF and OAT give encouraging clinical results for children under the age of 18 years.
Level 1: randomized controlled trial, significant difference.
本研究旨在比较关节镜下镶嵌式自体骨软骨移植（OAT）和微骨折（MF）手术治疗18岁以下儿童膝关节股骨髁剥脱性骨软骨炎（OCD）缺损的疗效。
前瞻性随机临床研究。
2001年至2005年期间，共有50例平均年龄为14.3岁（12至18岁）、膝关节股骨髁有症状性OCD病变的儿童被随机分为接受OAT或MF手术。仅纳入内侧或外侧股骨髁为3级或4级（根据国际软骨修复协会，ICRS）的儿童。47例患者（94%）可供随访。OAT组25例，MF组22例。症状平均持续时间为23.54±4.24个月，平均随访4.2年（3至6年），且所有儿童此前均未对患膝进行过手术干预。使用ICRS评分、X线、磁共振成像和二次关节镜检查对儿童进行评估。
1年后，两组临床均有显著改善（P<0.05），ICRS功能和客观评估显示，OAT术后25例中有23例（92%）结果为优或良，MF术后22例中有19例（86%）（无显著性差异），但4.2年（3至6年）后，OAT术后23例中有19例（83%）维持优或良的结果，MF术后19例中仅12例（63%）维持该结果。MF组在4.2年的随访中显示出显著恶化（P<0.05），但与术前评估相比仍有显著的临床改善（P=0.004）。MF组22例中有9例（41%）失败，OAT组无失败病例。根据ICRS评估系统进行的磁共振成像评估显示，OAT术后21例中有19例（91%）修复效果为优或良，MF术后18例中有10例（56%）。
平均随访4.2年，我们对18岁以下儿童进行的前瞻性随机临床研究表明，镶嵌式OAT在治疗膝关节剥脱性骨软骨炎缺损方面显著优于MF。然而，我们的研究表明，MF和OAT对18岁以下儿童均能产生令人鼓舞的临床效果。
1级：随机对照试验，有显著差异。
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