Department of Orthopedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
Knee Surg Sports Traumatol Arthrosc. 2012 Oct;20(10):1915-22. doi: 10.1007/s00167-011-1777-5. Epub 2011 Nov 18.
Several well-described techniques are available for the treatment of chondral and osteochondral defects. The aim of the study was to assess the efficacy of a single-stage procedure incorporating a new cell-free collagen type I gel for the treatment of small chondral and osteochondral defects in the knee evaluated at 2-year follow-up.
Fifteen patients were treated with a cell-free collagen type I gel matrix of 11 mm diameter. The grafts were implanted in the debrided cartilage defect and fixed by press-fit only. The clinical outcome was assessed preoperatively and at 6 weeks, and 6, 12 and 24 months after surgery using the International Knee Documentation Committee (IKDC) score, Tegner activity scale and visual analogue scale (VAS). Graft attachment rate was assessed 6 weeks postoperatively using magnetic resonance imaging (MRI). Cartilage regeneration was evaluated using the Magnetic Observation of Cartilage Repair Tissue (MOCART) score at 6, 12 and 24 months after implantation. Clinical results were correlated with MRI findings.
Six male and nine female patients were included in this study, with a mean age of 26 (range: 19-40). No complications were reported. The mean VAS values after 6 weeks and the mean IKDC patient values after 6 months were significantly improved from the preoperative values (P = 0.005 and P = 0.009, respectively). This improvement remained up to the latest follow-up. There were no significant differences between the median preoperative and postoperative Tegner values (n.s.). Significant improvement of the mean MOCART score was observed after 12 months and remained by 24 months (P < 0.001). MR images showed that in 14 of the 15 patients, the graft was completely attached by 6 weeks postoperatively. At 24 months after implantation, MRI demonstrated complete filling in all cases with a mainly smooth surface, complete integration of the border zone, homogenous structure of the repaired tissue and nearly normal signal intensity. No correlation between any variables of the MOCART score and the clinical scores was observed.
The present study reveals that the new method produces both good clinical and magnetic resonance imaging results. Use of press-fit only implanted grafts of a smaller diameter leads to a high attachment rate at 24-month follow-up.
IV.
有几种经过良好描述的技术可用于治疗软骨和软骨下骨缺损。本研究的目的是评估在 2 年随访时，使用新型无细胞 I 型胶原凝胶进行单次治疗，治疗膝关节小范围软骨和软骨下骨缺损的疗效。
15 名患者接受了直径为 11 毫米的无细胞 I 型胶原凝胶基质治疗。将移植物植入清创后的软骨缺损处，仅通过压配合固定。术前及术后 6 周、6、12 和 24 个月，采用国际膝关节文献委员会（IKDC）评分、Tegner 活动量表和视觉模拟评分（VAS）评估临床结果。术后 6 周，采用磁共振成像（MRI）评估移植物附着率。采用磁共振软骨修复组织观察评分（MOCART）在植入后 6、12 和 24 个月评估软骨再生情况。临床结果与 MRI 结果相关。
本研究共纳入 6 名男性和 9 名女性患者，平均年龄 26 岁（19-40 岁）。无并发症报告。术后 6 周 VAS 均值和术后 6 个月 IKDC 患者均值与术前相比显著改善（P = 0.005 和 P = 0.009）。这种改善一直持续到最新随访。术前和术后中位数 Tegner 值之间无显著差异（n.s.）。术后 12 个月 MOCART 评分显著提高，24 个月时仍保持（P < 0.001）。MRI 显示，15 例患者中有 14 例在术后 6 周时移植物完全附着。植入后 24 个月，MRI 显示所有病例均完全填充，表面基本光滑，边界区完全融合，修复组织结构均匀，信号强度接近正常。未观察到 MOCART 评分的任何变量与临床评分之间存在相关性。
本研究表明，新方法既产生了良好的临床和磁共振成像结果。使用较小直径的仅压配合植入移植物可使 24 个月时的附着率较高。
IV 级。
