Department of Orthopaedics and Trauma, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck, Germany.
Knee Surg Sports Traumatol Arthrosc. 2010 Nov;18(11):1456-64. doi: 10.1007/s00167-010-1042-3. Epub 2010 Feb 2.
Articular cartilage defects heal poorly. Autologous Matrix-Induced Chondrogenesis (AMIC) is an innovative treatment for localized full-thickness cartilage defects combining the well-known microfracturing with collagen scaffold and fibrin glue. The purpose of this prospective study was to evaluate the medium-term results of this enhanced microfracture technique for the treatment of chondral lesions of the knee. Thirty-two chondral lesions in 27 patients were treated with AMIC. Within the context of clinical follow-up, these patients were evaluated for up to 5 years after the intervention. Five different scores (Meyer score, Tegner score, Lysholm score, ICRS score, Cincinnati score) as well as radiographs were used for outcome analysis. Articular resurfacing was assessed by magnetic resonance imaging (MRI). The average age of patients (11 females, 16 males; mean body mass index 26, range 20-32) was 37 years (range 16-50 years). The mean defect size of the chondral lesions was 4.2 cm(2) (range 1.3-8.8 cm(2)). All defects were classified as grade IV according to the Outerbridge classification. The follow-up period was between 24 and 62 months with a mean of 37 months. Twenty out of 23 individuals (87%) questioned were subjectively highly satisfied with the results after surgery. Significant improvement (P < 0.05) of all scores was observed as early as 12 months after AMIC, and further increased values were notable up to 24 months postoperatively. MRI analysis showed moderate to complete filling with a normal to incidentally hyperintense signal in most cases. Results did not show a clinical impact of patient's age at the time of operation, body mass index and number of previous operations (n.s.). In contrast, males showed significant higher values in the ICRS score compared to their female counterparts. AMIC is an effective and safe method of treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases. However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time.
关节软骨缺损愈合不良。自体基质诱导软骨生成术（AMIC）是一种创新的治疗方法，可将广为人知的微骨折技术与胶原支架和纤维蛋白胶相结合，用于治疗局限性全层软骨缺损。本前瞻性研究的目的是评估这种增强型微骨折技术治疗膝关节软骨病变的中期结果。27 名患者的 32 个软骨病变采用 AMIC 治疗。在临床随访过程中，这些患者在干预后最长 5 年进行评估。使用 5 种不同的评分（Meyer 评分、Tegner 评分、Lysholm 评分、ICRS 评分、辛辛那提评分）以及 X 线片进行结果分析。通过磁共振成像（MRI）评估关节表面重塑。患者的平均年龄（11 名女性，16 名男性；平均体重指数 26，范围 20-32）为 37 岁（范围 16-50 岁）。软骨病变的平均缺损大小为 4.2cm²（范围 1.3-8.8cm²）。所有缺损均根据 Outerbridge 分类法评为 IV 级。随访时间为 24 至 62 个月，平均为 37 个月。23 名被调查的个体中有 20 名（87%）主观上对手术后的结果非常满意。在 AMIC 后 12 个月，所有评分均观察到显著改善（P<0.05），术后 24 个月时进一步增加。MRI 分析显示，在大多数情况下，中等至完全填充，信号正常至偶然高信号。结果未显示手术时患者年龄、体重指数和既往手术次数的临床影响（n.s.）。相比之下，男性在 ICRS 评分中的值明显高于女性。AMIC 是治疗适当选择的膝关节全层软骨缺损的有效且安全的方法。然而，需要进一步的长期随访研究来确定移植物区域是否会随着时间的推移保持结构和功能的完整性。
