University Hospitals Leuven, Department of Development and Regeneration, Division of Orthopedics and Traumatology, Weligerveld 1, Pellenberg, Leuven, 3212 Belgium.
Am J Sports Med. 2012 Aug;40(8):1799-807. doi: 10.1177/0363546512452712. Epub 2012 Jul 11.
Autologous chondrocyte implantation (ACI) is an accepted treatment option for selected condylar cartilage defects in the knee. Results for patellofemoral chondral defects have been less favorable.
Autologous chondrocyte implantation with characterized chondrocytes will result in clinically relevant improvement in patellofemoral lesions.
Case series; Level of evidence, 4.
Patients with symptomatic patellofemoral full-thickness cartilage lesions were treated with ACI using characterized chondrocytes (ChondroCelect) covered with a collagen type I membrane. Clinical outcome was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and a visual analog scale (VAS) for pain. Responders were defined using 5 categories (≥10 points and ≥20%, 30%, 50%, 70%) based on the KOOS and VAS. Treatment failure was defined as partial loosening of more than 20% of the graft with subsequent procedures to the subchondral bone.
Thirty-eight patients, with a mean defect size of 4.89 cm(2) (range, 1.5-11 cm(2)), were treated for a patellar defect (n = 28), trochlear defect (n = 7), or a kissing lesion (trochlea and patella; n = 3). The minimum follow-up period was 24 months (mean, 37 months; range, 24-72 months). Treated patients showed statistically significant improvements in the KOOS (at 12, 18, 24, 36, and 48 months) and VAS (at the same time points) compared with pretreatment for each time point. Responder analysis identified approximately 84% of patients with a clinically relevant improvement greater than 10 points at 3 years. Treatment failure was observed in 5 patients. The most commonly reported adverse events were joint crepitation (n = 18) and arthrofibrosis (n = 7). No relationship could be found between clinical outcome and anatomic characteristics of the patellofemoral joint, lesion size and site, time since onset, or age. Nine patients required additional surgery: 6 because of persistent symptoms and 3 for hardware removal.
Characterized chondrocyte implantation resulted in statistically significant and clinically relevant improvement over time. These results add to the evidence demonstrating that ACI is a valuable cartilage repair technique for patellofemoral lesions.
自体软骨细胞移植（ACI）是一种被认可的治疗膝关节特定部位髁状突软骨缺损的方法。髌股关节软骨缺损的治疗效果则不尽人意。
使用具有特征的软骨细胞进行自体软骨细胞移植将导致髌股病变的临床相关改善。
病例系列；证据水平，4 级。
患有症状性髌股关节全层软骨缺损的患者采用具有特征的软骨细胞（ChondroCelect）进行 ACI 治疗，这些软骨细胞被胶原 I 膜覆盖。使用膝关节损伤和骨关节炎结果评分（KOOS）和疼痛视觉模拟量表（VAS）评估临床结果。根据 KOOS 和 VAS，使用 5 个类别（≥10 分和≥20%、30%、50%、70%）定义应答者。治疗失败定义为移植物的 20%以上部分松动，随后对软骨下骨进行手术。
38 例患者（平均缺损面积为 4.89cm²（范围为 1.5-11cm²））接受了治疗，其中 28 例为髌骨缺损，7 例为滑车缺损，3 例为吻合并发症（滑车和髌骨）。最短随访时间为 24 个月（平均 37 个月；范围为 24-72 个月）。与治疗前相比，治疗后的患者在 KOOS（12、18、24、36 和 48 个月）和 VAS（同一时间点）均有统计学意义上的改善。应答者分析显示，3 年后约 84%的患者有大于 10 分的临床显著改善。5 例患者出现治疗失败。最常见的不良事件包括关节弹响（18 例）和关节纤维化（7 例）。未发现临床结果与髌股关节解剖特征、病变大小和部位、发病时间或年龄之间存在任何关系。9 例患者需要进一步手术：6 例因持续症状，3 例因去除内固定。
特征性软骨细胞移植随时间推移可显著改善临床症状。这些结果增加了证据表明，ACI 是治疗髌股病变的一种有价值的软骨修复技术。
