Niemeyer P, Salzmann G M, Hirschmüller A, Südkamp N P
Department für Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Hugstetterstrasse 55, Freiburg.
Z Orthop Unfall. 2012 Feb;150(1):83-8. doi: 10.1055/s-0030-1270894. Epub 2011 Apr 27.
Since its introduction in 1994, autologous chondrocyte implantation (ACI) has become an established surgical treatment for symptomatic isolated cartilage defects of the knee. Success rates vary between 80 and 95% and the clinical outcome seems to depend on various individual factors. The aim of the present review article is to summarise factors that affect clinical outcome following ACI for treatment of symptomatic cartilage defects of the knee based upon the scientific literature available on this topic.
The present publication represents a non-systematic review including publications which were considered relevant describing factors that influence clinical outcome following ACI for treatment of symptomatic full thickness cartilage defects of the knee. In order to identify relevant literature concerning complications following cartilage repair, medical databases including "medline", "ovid" and "web of science" were searched for the terms "autologous chondrocyte implantation", "autologous chondrocyte transplantation", "prognostic factor", "clinical outcome", "cartilage repair", "cartilage defect" and "cartilage regeneration". The literature search was performed in April 2010.
Factors that influence clinical outcome following ACI for treatment of cartilage defects of the knee include patient-specific parameters on the one hand, such as body mass index, nicotine abusus, patients age, prior surgical treatment, duration of symptoms and more, and defect characteristics such as containment, defect location, defect size, number of defects treated, on the other hand. Furthermore, surgical technique, cell quality and rehabilitation seem to significantly influence the clinical outcome following autologous chondrocyte implantation. Among all factors identified as relevant for clinical outcome, some of these parameters are fixed and cannot be changed by either the surgeon nor the patient, while others can be influenced and even changed during the treatment and rehabilitation of a patient who underwent ACI.
Knowledge of all relevant parameters that influence clinical outcome following ACI is essential in order to achieve an optimal clinical outcome in patients with cartilage defects of the knee. This paper presents a review of the scientific literature available which focuses on the questions as to what parameters influence the outcome of a patient following ACI for treatment of cartilage defects of the knee. No isolated factors could be identified that influence the outcome following ACI alone, but it seems that clinical outcome is influenced by many different parameters. These parameters should be considered carefully, at the time of decision about what kind of treatment is applied. Furthermore, the patient should be informed especially about those parameters which can be influenced by him-/herself in order to create good prerequisites for the surgical treatment.
自1994年自体软骨细胞植入术（ACI）问世以来，它已成为治疗膝关节有症状的孤立性软骨缺损的一种既定外科治疗方法。成功率在80%至95%之间，临床结果似乎取决于多种个体因素。本综述文章的目的是根据关于该主题的现有科学文献，总结影响ACI治疗膝关节有症状软骨缺损后临床结果的因素。
本出版物是一项非系统性综述，纳入了被认为相关的描述影响ACI治疗膝关节有症状全层软骨缺损后临床结果的因素的文献。为了确定有关软骨修复后并发症的相关文献，在包括“medline”、“ovid”和“科学网”在内的医学数据库中搜索了“自体软骨细胞植入”、“自体软骨细胞移植”、“预后因素”、“临床结果”、“软骨修复”、“软骨缺损”和“软骨再生”等术语。文献检索于2010年4月进行。
影响ACI治疗膝关节软骨缺损后临床结果的因素一方面包括患者特定参数，如体重指数、吸烟、患者年龄、既往手术治疗、症状持续时间等，另一方面包括缺损特征，如包容情况、缺损位置、缺损大小、治疗的缺损数量等。此外，手术技术、细胞质量和康复似乎对自体软骨细胞植入后的临床结果有显著影响。在所有被确定为与临床结果相关的因素中，其中一些参数是固定的，外科医生和患者都无法改变，而其他一些参数在接受ACI治疗的患者的治疗和康复过程中可以受到影响甚至改变。
了解所有影响ACI后临床结果的相关参数对于在膝关节软骨缺损患者中实现最佳临床结果至关重要。本文对现有科学文献进行了综述，重点关注哪些参数会影响接受ACI治疗膝关节软骨缺损患者的结果这一问题。没有发现单独影响ACI后结果的孤立因素，但临床结果似乎受到许多不同参数的影响。在决定采用何种治疗方法时，应仔细考虑这些参数。此外，应特别告知患者那些可由其自身影响的参数，以便为手术治疗创造良好的前提条件。
