Department for Orthopedic Surgery and Traumatology, Freiburg University Hospital, Germany.
Am J Sports Med. 2012 Feb;40(2):325-31. doi: 10.1177/0363546511425651. Epub 2011 Nov 5.
Although various factors have been identified that influence outcome after autologous chondrocyte implantation (ACI), the relevance of prior treatment of the cartilage defect and its effect concerning the outcome of second-line ACI have not been evaluated to a full extent.
Autologous chondrocyte implantation used as a second-line treatment after failed arthroscopic microfracturing is associated with a higher failure rate and inferior clinical results compared with ACI as a first-line treatment.
Cohort study; Level of evidence, 3.
A total of 28 patients with isolated cartilage defects at the knee joint were treated with ACI after microfracture as a first-line treatment had failed (failure defined as the necessity of reintervention). These patients were assigned to group A and compared with a matched-pair cohort of patients of identical age, defect size, and defect location (group B) in which ACI was used as a first-line treatment. Failure rates in both groups were assessed. Postoperative knee status was evaluated with the International Knee Documentation Committee (IKDC) score and Knee injury and Osteoarthritis Outcome Score (KOOS), and sporting activity was assessed by use of the Activity Rating Scale. Mean follow-up times were 48.0 months (range, 15.1-75.1 months) in group A and 41.4 months (range, 15.4-83.6 months) in group B. Differences between groups A and B were analyzed by Student t test.
Group A had significantly greater failure rates (7 of 28 patients) in comparison with group B (1 of 28 patients; P = .0241). Mean (SD) postoperative IKDC scores revealed 58.4 (22.4) points in group A with a trend toward higher score results (69.0 [19.1] points) for patients in group B (P = .0583). Significantly different results were obtained for KOOS pain and activity of daily living subscales, whereas the remaining KOOS subscales did not show significant differences. Despite the significantly higher failure rate observed in group A, those patients did not participate in fewer activities or perform physical activity less frequently or at a lower intensity.
Autologous chondrocyte implantation after failed microfracturing appears to be associated with a significantly higher failure rate and inferior clinical outcome when compared with ACI as a first-line treatment.
尽管已经确定了许多影响自体软骨细胞移植（ACI）后结果的因素，但软骨缺陷的先前治疗及其对二线 ACI 结果的影响尚未得到充分评估。
作为关节镜下微骨折术失败后的二线治疗，自体软骨细胞植入与作为一线治疗相比，失败率更高，临床结果更差。
队列研究；证据水平，3 级。
共有 28 例膝关节孤立性软骨缺陷患者在微骨折术失败后接受 ACI 治疗（失败定义为需要再次干预）。这些患者被分为 A 组，并与相同年龄、缺陷大小和缺陷位置的配对患者队列（B 组）进行比较，其中 ACI 被用作一线治疗。评估两组的失败率。术后膝关节状况采用国际膝关节文献委员会（IKDC）评分和膝关节损伤和骨关节炎结果评分（KOOS）进行评估，运动能力采用活动评级量表进行评估。A 组的平均随访时间为 48.0 个月（范围，15.1-75.1 个月），B 组为 41.4 个月（范围，15.4-83.6 个月）。通过学生 t 检验分析组 A 和组 B 之间的差异。
与组 B（28 例患者中的 1 例；P =.0241）相比，组 A 的失败率（28 例患者中有 7 例）明显更高。组 A 的平均（SD）术后 IKDC 评分为 58.4（22.4）分，组 B 的评分结果呈上升趋势（69.0 [19.1]分）（P =.0583）。KOOS 疼痛和日常生活活动亚量表的结果差异显著，而其余 KOOS 亚量表的结果无显著差异。尽管组 A 的失败率明显较高，但这些患者的活动参与度并未减少，也未减少活动频率或活动强度。
与作为一线治疗的 ACI 相比，微骨折术失败后进行自体软骨细胞植入似乎与更高的失败率和更差的临床结果相关。
