Department of Orthopaedic Surgery, University Medical Center Rostock, Rostock, Germany.
Am J Sports Med. 2011 Aug;39(8):1697-705. doi: 10.1177/0363546511403279. Epub 2011 May 3.
Scaffold-assisted autologous chondrocyte implantation is a clinically effective procedure for cartilage repair, but biomechanical evaluations are still missing.
This study was conducted to assess the clinical efficacy, including biomechanical analyses, of BioSeed-C treatment for traumatic and degenerative cartilage defects of the knee.
Case series; Level of evidence, 4.
The authors evaluated the midterm clinical and biomechanical outcome of BioSeed-C, a cell-based fibrin-polymer graft for the treatment of cartilage defects. Clinical outcome at 4-year follow-up was assessed in 52 patients with full-thickness cartilage defects, International Cartilage Repair Society (ICRS) stage III and IV. Clinical scoring was performed preoperatively and 48 months after implantation using the Lysholm score, the International Knee Documentation Committee (IKDC) score, the ICRS score, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Noyes score. Cartilage regeneration was assessed by magnetic resonance imaging (MRI) using the Henderson-Kreuz score. Biomechanical evaluation was performed by isokinetic strength measurements, comparing healthy and operated knee of each patient.
Clinical evaluation showed significant improvement in the Lysholm (from 51.8 preoperatively to 80.7 at 48 months postoperatively), IKDC (from 47.5 to 71.5), ICRS (from 3.8 to 2.0), KOOS (subcategory pain from 62 to 78, symptoms from 68 to 76, activities of daily living from 68 to 85, sports from 19 to 55, and quality of life from 30 to 55), and Noyes (from 31 to 59) scores (P ≤ .001) 48 months after implantation of BioSeed-C compared with the preoperative situation. The MRI evaluations showed moderate to complete defect filling in 43 of 44 treated patients. Two patients without improvement in the clinical and MRI scores received a total knee endoprosthesis after 4 years. Isokinetic evaluation showed significantly reduced maximum strength capacities for knee flexion and extension at the operated knee compared with the healthy knee (P < .05).
The clinical outcomes 4 years after graft implantation are good despite a persisting strength deficit. Implanting BioSeed-C is a promising treatment option for cartilage defects of the knee. More emphasis should be put on the rehabilitation of muscular strength.
支架辅助自体软骨细胞移植是一种临床有效的软骨修复方法，但仍缺乏生物力学评估。
本研究旨在评估 BioSeed-C 治疗膝关节创伤性和退行性软骨缺损的临床疗效，包括生物力学分析。
病例系列；证据水平，4 级。
作者评估了细胞纤维蛋白聚合物移植物 BioSeed-C 治疗全层软骨缺损的中期临床和生物力学结果。对 52 例 ICRS Ⅲ期和Ⅳ期全层软骨缺损患者进行了 4 年随访的临床结果评估。术前和植入后 48 个月分别采用 Lysholm 评分、国际膝关节文献委员会（IKDC）评分、ICRS 评分、膝关节损伤和骨关节炎评分（KOOS）和 Noyes 评分进行临床评分。采用 Henderson-Kreuz 评分对磁共振成像（MRI）评估软骨再生。通过等速力量测量对生物力学进行评估，比较每位患者健康侧和手术侧的膝关节。
临床评估显示 Lysholm（从术前 51.8 分提高到术后 48 个月的 80.7 分）、IKDC（从 47.5 分提高到 71.5 分）、ICRS（从 3.8 分提高到 2.0 分）、KOOS（疼痛亚类从 62 分提高到 78 分，症状从 68 分提高到 76 分，日常生活活动从 68 分提高到 85 分，运动从 19 分提高到 55 分，生活质量从 30 分提高到 55 分）和 Noyes（从 31 分提高到 59 分）评分在 BioSeed-C 植入后 48 个月显著提高（P ≤.001）与术前情况相比。MRI 评估显示 44 例治疗患者中有 43 例有中度至完全缺陷填充。两名临床和 MRI 评分无改善的患者在 4 年后接受了全膝关节置换术。与健康侧相比，等速评估显示手术侧膝关节的最大屈伸力量明显降低（P <.05）。
尽管存在持续的力量缺陷，但植入后 4 年的临床结果良好。植入 BioSeed-C 是治疗膝关节软骨缺损的一种很有前途的治疗选择。应更加重视肌肉力量的康复。
