Servei de Cirurgia Ortopèdica i Traumatologia, Unitat de Genoll, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebrón 119-129, 08035 Barcelona, Spain.
Am J Sports Med. 2012 Jun;40(6):1289-95. doi: 10.1177/0363546512441585. Epub 2012 Apr 5.
Surgical management of patellar cartilage defects remains controversial. The ideal technique to regenerate hyaline cartilage is not yet defined. However, a synthetic resorbable osteochondral scaffold plug (TruFit CB) seems to offer a treatment option with good results at short-term follow-up, at least in the condylar setting.
A synthetic implant provides a simple and efficacious means of treating the cartilage defects of the patellofemoral joint in young patients.
Case series; Level of evidence, 4.
A study was designed to evaluate prospectively short- and medium-term results in patients with osteochondral patellar defects treated with synthetic reabsorbable scaffolds. Patient outcome scores (Short Form 36 [SF-36] and Knee injury and Osteoarthritis Outcome Score [KOOS]), demographics, prior surgeries, and data from a physical examination were collected at baseline (before implantation) and at 6, 12, and 24 months after surgery. Defect characteristics were collected during implantation. Diagnosis and monitoring were performed by magnetic resonance imaging.
Ten patients with a mean age of 33.3 years (range, 16-49 years) were evaluated prospectively at 24 months' follow-up. The number of plugs used for each patient ranged from 1 to 4. At 1-year follow-up, the results were satisfactory in 8 of 10 patients, and poor in 2, according to clinical assessment (KOOS, visual analog scale, and SF-36). At 18 months of follow-up, all patients except one complained of pain and knee swelling. Reoperation rate for implant failure at final follow-up was 70%. Magnetic resonance imaging at final follow-up showed a cylindrical cavity of fibrous tissue instead of subchondral bone restoration.
A synthetic implant can improve symptoms and joint function, especially for small lesions, only for a short period of time. However, 2 years of monitoring has shown its failure in restoring the subchondral bone despite the formation of predominant hyaline cartilage from synthetic resorbable scaffolds. Under current conditions and according to our experience, we do not recommend TruFit synthetic implants for osteochondral patellar defects in active patients.
髌骨软骨缺损的外科治疗仍存在争议。目前尚未明确能再生透明软骨的理想技术。然而，一种合成可吸收的骨软骨嵌塞物（TruFit CB）似乎为短期随访提供了一种有良好结果的治疗选择，至少在髁间窝是这样。
一种合成植入物为治疗年轻患者髌股关节软骨缺损提供了一种简单有效的方法。
病例系列；证据水平，4 级。
本研究旨在前瞻性评估使用合成可吸收支架治疗骨软骨髌骨缺损患者的短期和中期结果。在植入前、术后 6、12 和 24 个月收集患者的结果评分（SF-36 简明量表和 KOOS）、人口统计学资料、既往手术以及体格检查数据。在植入过程中收集缺损特征。诊断和监测通过磁共振成像进行。
10 例患者平均年龄为 33.3 岁（1649 岁），24 个月时进行前瞻性评估。每位患者使用的嵌塞物数量为 14 个。根据临床评估（KOOS、视觉模拟评分和 SF-36），1 年随访时 10 例患者中有 8 例结果满意，2 例结果不佳。18 个月随访时，除 1 例外所有患者均诉疼痛和膝关节肿胀。最终随访时，植入物失败的再次手术率为 70%。最终随访时的磁共振成像显示，纤维组织的圆柱形腔而非软骨下骨修复。
合成植入物可改善症状和关节功能，特别是对小病变，仅在短时间内有效。然而，2 年的监测显示，尽管合成可吸收支架形成了主要的透明软骨，但仍未能恢复软骨下骨。根据目前的情况和我们的经验，我们不建议在活跃的患者中使用 TruFit 合成植入物治疗骨软骨髌骨缺损。
