Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,
Clin Orthop Relat Res. 2014 Jan;472(1):41-51. doi: 10.1007/s11999-013-3146-9.
Autologous chondrocyte implantation (ACI) has demonstrated good and excellent results in over 75% of patients up to 10 years after surgery. Reports of longer-term outcomes, however, remain limited.
QUESTIONS/PURPOSES: The purposes of this study were to describe the (1) survivorship of ACI grafts; (2) the long-term functional outcomes using validated scoring tools after ACI; and (3) to provide an analysis of potential predictors for failure.
Two hundred ten patients treated with ACI were followed for more than 10 years. Indications for the procedure included symptomatic cartilage defects in all compartments of the knee unresponsive to nonoperative measures. Mean age at surgery was 36 ± 9 years; mean defect size measured 8.4 ± 5.5 cm(2). Outcome scores were prospectively collected pre- and postoperatively at the last followup.
At a mean of 12 ± 2 years followup, 53 of 210 patients (25%) had at least one failed ACI graft. Nineteen of these patients went on to arthroplasty, 27 patients were salvaged with revision cartilage repair, and seven patients declined further treatment; three patients were lost to followup. The modified Cincinnati increased from 3.9 ± 1.5 to 6.4 ± 1.5, WOMAC improved from 39 ± 21 to 23 ± 16, Knee Society Score (KSS) knee score rose from 54 ± 18 to 79 ± 19, and KSS function from 65 ± 23 to 78 ± 17 (all p < 0.0001). The Physical Component of the SF-36 score increased from 33 ± 14 to 49 ± 18, whereas the Mental Component improved from 46 ± 14 to 52 ± 15 (both p < 0.001). Survivorship was higher in patients with complex versus salvage-type lesions (p = 0.03) with primary ACI versus ACI after prior marrow stimulation (p = 0.004) and with concomitant high tibial osteotomy (HTO) versus no HTO (p = 0.01).
ACI provided durable outcomes with a survivorship of 71% at 10 years and improved function in 75% of patients with symptomatic cartilage defects of the knee at a minimum of 10 years after surgery. A history of prior marrow stimulation as well as the treatment of very large defects was associated with an increased risk of failure.
自体软骨细胞移植（ACI）在术后 10 年以上的患者中超过 75%表现出良好和优秀的结果。然而，关于更长期结果的报告仍然有限。
问题/目的：本研究的目的是描述：（1）ACI 移植物的存活率；（2）ACI 后使用经过验证的评分工具的长期功能结果；（3）分析失败的潜在预测因素。
210 例接受 ACI 治疗的患者随访时间超过 10 年。该手术的适应证包括所有膝关节腔的症状性软骨缺损，对非手术治疗无反应。手术时的平均年龄为 36±9 岁；平均缺损大小为 8.4±5.5cm²。在最后一次随访时，前瞻性地收集术前和术后的结果评分。
在平均 12±2 年的随访中，210 例患者中有 53 例（25%）至少有 1 个 ACI 移植物失败。其中 19 例患者进行了关节置换，27 例患者接受了软骨修复翻修，7 例患者拒绝进一步治疗；3 例患者失访。改良辛辛那提评分从 3.9±1.5 增加到 6.4±1.5，WOMAC 从 39±21 改善到 23±16，膝关节协会评分（KSS）膝关节评分从 54±18 增加到 79±19，KSS 功能从 65±23 增加到 78±17（均 p<0.0001）。SF-36 评分的身体成分从 33±14 增加到 49±18，而精神成分从 46±14 增加到 52±15（均 p<0.001）。与简单型病变相比，复杂型和挽救型病变患者的生存率更高（p=0.03），初次 ACI 与 ACI 后骨髓刺激（p=0.004）以及与同期高位胫骨截骨术（HTO）与无 HTO（p=0.01）相比，生存率更高。
ACI 在膝关节症状性软骨缺损患者中至少 10 年后提供了持久的结果，10 年生存率为 71%，75%的患者功能得到改善。既往骨髓刺激史以及大缺损的治疗与失败风险增加有关。
