II Clinic–Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136 Bologna, Italy.
Am J Sports Med. 2013 Aug;41(8):1786-93. doi: 10.1177/0363546513490658. Epub 2013 Jun 12.
Osteochondritis dissecans (OCD) is an acquired lesion of the subchondral bone that may result in separation and instability of the overlying articular cartilage. Unstable lesions must be treated surgically to reestablish the joint surface as anatomically as possible. Hypothesis/
The aim of this study was to evaluate the potential of a biomimetic osteochondral scaffold to treat OCD by analyzing the results obtained at 2-year follow-up. The hypothesis was that this scaffold, which was developed to treat the entire osteochondral unit, might restore the articular surface and improve symptoms and function in patients affected by knee OCD.
Case series; Level of evidence, 4.
Twenty-seven consecutive patients (19 men, 8 women; age [mean ± SD], 25.5 ± 7.7 years) who were affected by symptomatic knee OCD of the femoral condyles (average defect size 3.4 ± 2.2 cm(2)), grade 3 or 4 on the International Cartilage Repair Society (ICRS) scale, were enrolled and treated with the implantation of a 3-layer collagen-hydroxyapatite scaffold. Patients were prospectively evaluated by subjective and objective International Knee Documentation Committee (IKDC) and Tegner scores preoperatively and at 1- and 2-year follow-up. An MRI was also performed at the 2 follow-up times.
A statistically significant improvement in all clinical scores was obtained at 1 year, and a further improvement was found the following year. At the 2-year follow-up, the IKDC subjective score had increased from 48.4 ± 17.8 preoperatively to 82.3 ± 12.2, the IKDC objective evaluation from 40% to 85% of normal knees, and the Tegner score from 2.4 ± 1.7 to 4.5 ± 1.6. The MRI evaluations showed good defect filling and implant integration but also inhomogeneous regenerated tissue and subchondral bone changes in most patients at both follow-up times. No correlation between the MOCART (magnetic resonance observation of cartilage repair tissue) score and clinical outcome was found.
This biomimetic osteochondral scaffold seems to be a valid treatment option for knee OCD, showing a good clinical outcome at 2-year follow-up. Moreover, the improvement was not correlated with lesion size, so large lesions can benefit from this implant. Less favorable findings were obtained with MRI evaluation.
剥脱性骨软骨炎（OCD）是一种发生于软骨下骨的获得性病变，可能导致覆盖其上的关节软骨分离和不稳定。不稳定的病变必须通过手术治疗，以尽可能恢复解剖学上的关节表面。
假设/目的：本研究旨在通过分析 2 年随访结果评估仿生骨软骨支架治疗 OCD 的潜力。假设这种支架是为治疗整个骨软骨单位而开发的，可能会恢复关节表面并改善受膝 OCD 影响的患者的症状和功能。
病例系列；证据水平，4 级。
27 例连续患者（19 名男性，8 名女性；年龄[均值±标准差]，25.5±7.7 岁）患有症状性股骨髁 OCD（平均缺损大小 3.4±2.2cm2），国际软骨修复学会（ICRS）分级 3 或 4 级，接受 3 层胶原-羟基磷灰石支架植入治疗。患者在术前和 1 年及 2 年随访时，通过主观和客观国际膝关节文献委员会（IKDC）和 Tegner 评分进行前瞻性评估。在 2 次随访时还进行了 MRI 检查。
1 年后所有临床评分均有统计学显著改善，次年进一步改善。在 2 年随访时，IKDC 主观评分从术前的 48.4±17.8 增加到 82.3±12.2，IKDC 客观评估从正常膝关节的 40%增加到 85%，Tegner 评分从 2.4±1.7 增加到 4.5±1.6。MRI 评估显示在大多数患者的两个随访时间内，缺损填充和植入物整合良好，但也存在不均匀的再生组织和软骨下骨改变。MOCART（磁共振软骨修复组织观察）评分与临床结果之间没有相关性。
这种仿生骨软骨支架似乎是治疗膝 OCD 的有效选择，在 2 年随访时具有良好的临床效果。此外，改善与病变大小无关，因此大病变可受益于该植入物。MRI 评估的结果较差。
