II Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
Am J Sports Med. 2013 Mar;41(3):511-8. doi: 10.1177/0363546512467622. Epub 2012 Dec 5.
A recent one-step arthroscopic technique based on bone marrow-derived cell transplantation has achieved good results in repairing osteochondral lesions of the talus (OLTs), overcoming some of the drawbacks of older techniques.
To report the results after 4 years of a series of patients who underwent a one-step repair of osteochondral lesions of the talar dome, as well as the capability of magnetic resonance imaging (MRI) using a T2-mapping sequence to predict the clinical outcome.
Case series; Level of evidence, 4.
Forty-nine patients (age [mean ± SD], 28.08 ± 9.51 y) underwent a one-step repair of OLTs. Patients were evaluated clinically by American Orthopaedic Foot and Ankle Society (AOFAS) scores and radiographs and underwent MRI preoperatively and during postoperative follow-ups at predetermined times. In all patients, the cells were harvested from the iliac crest, concentrated, and loaded on a scaffold that was implanted arthroscopically.
The overall AOFAS score (mean ± SD) improved from 63.73 ± 14.13 preoperatively to 82.19 ± 17.04 at 48 ± 6.1 months (P < .0005), with best results at the 24-month follow-up. A significant decrease in the clinical score was observed between 24 and 36 months postoperatively (P = .001) and between 24 and 48 months (P < .005). The T2-mapping analysis showed regenerated tissue with T2 values of 35 to 45 milliseconds, similar to hyaline cartilage, in a mean of 78% ± 16% of the repaired lesion area. The time between the occurrence of trauma and surgery was found to negatively affect the clinical outcome at the latest follow-up; patient's age and lesion size influenced the early clinical results but did not affect the outcome at final follow-up. The stability of clinical results over time and the percentage of tissue with values similar to hyaline cartilage evidenced by MRI T2 mapping showed a tendency to correlate at the last follow-up (r = 0.497, P = .06).
One-step repair of OLTs had good clinical results that were durable over time, even though there was a slight decrease in AOFAS score at the latest follow-up. The quality of the regenerated tissue detected by MRI T2 mapping directly correlated with the clinical results.
最近一种基于骨髓源性细胞移植的一步法关节镜技术在修复距骨骨软骨病变（OLTs）方面取得了良好的效果，克服了一些旧技术的缺点。
报告一系列接受距骨穹顶骨软骨病变一步修复的患者的 4 年结果，以及使用 T2 映射序列的磁共振成像（MRI）预测临床结果的能力。
病例系列；证据水平，4 级。
49 例患者（年龄[均值±标准差]，28.08±9.51 岁）接受了 OLTs 的一步修复。患者通过美国矫形足踝协会（AOFAS）评分和 X 线进行临床评估，并在术前和术后预定时间进行 MRI 检查。在所有患者中，细胞均从髂嵴采集、浓缩，并加载到关节镜下植入的支架上。
整体 AOFAS 评分（均值±标准差）从术前的 63.73±14.13 改善至 48±6.1 个月时的 82.19±17.04（P<.0005），在 24 个月随访时最佳。术后 24 至 36 个月（P=.001）和 24 至 48 个月（P<.005）时，临床评分显著下降。T2 映射分析显示，再生组织的 T2 值为 35 至 45 毫秒，与透明软骨相似，在修复病变区域的平均 78%±16%中。研究发现，创伤与手术之间的时间间隔对末次随访时的临床结果有负面影响；患者年龄和病变大小影响早期临床结果，但不影响最终随访时的结果。随着时间的推移，临床结果的稳定性和 MRI T2 映射显示的类似透明软骨的组织百分比显示出在末次随访时呈正相关的趋势（r=0.497，P=.06）。
OLTs 的一步修复具有良好的临床效果，随着时间的推移持久，尽管在末次随访时 AOFAS 评分略有下降。MRI T2 映射检测到的再生组织质量与临床结果直接相关。
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