Brix Martin O, Stelzeneder David, Chiari Catharina, Koller Ulrich, Nehrer Stefan, Dorotka Ronald, Windhager Reinhard, Domayer Stephan E
Department of Orthopaedics, Medical University of Vienna, Vienna, Austria
Department of Orthopaedics, Medical University of Vienna, Vienna, Austria.
Am J Sports Med. 2014 Jun;42(6):1426-32. doi: 10.1177/0363546514526695. Epub 2014 Mar 24.
Matrix-associated autologous chondrocyte transplantation (MACT) has become an established articular cartilage repair technique. It provides good short-term and midterm results; however, long-term results are lacking.
To prospectively assess the clinical outcome after MACT in the knee to report long-term results.
Case series; Level of evidence, 4.
Fifty-three subjects (females/males, 22/31; mean age, 32 ± 12 years) were treated between 2000 and 2006 with a hyaluronan-based MACT product and were followed prospectively. The mean body mass index (BMI) was 24.5 ± 3.8 kg/m(2) and the mean defect size was 4.4 ± 1.9 cm(2). Fifty patients had single defects and 3 had multiple defects (41 medial femoral condyle, 6 lateral femoral condyle, 2 patella, 1 tibia). Two patients had 2 defects (medial femoral condyle [MFC]/lateral femoral condyle and tibial/MFC), and in 1 case, multiple defects on the MFC were treated. The patients were stratified into 23 "simple," 22 "complex," and 8 "salvage" cases. Instability or malalignment was treated before or at the time of graft implantation. For 6 patients with small defects (<2 cm(2)), microfracturing was used as first-line treatment before MACT. Clinical assessment was performed once a year with the subjective and objective International Knee Documentation Committee (IKDC) scores, Lysholm score, and a modified Cincinnati Knee Rating System.
The mean follow-up time was 9.07 ± 2.9 years (range, 5-12 years). Treatment failure occurred in 12 of 53 cases (22.6%) an average of 2.99 ± 1.40 years after surgery. There was 1 failure (4.3%) among the simple cases, 4 failures (18.2%) in complex cases, and 7 failures (87.5%) in salvage cases. Statistically significant increases were observed in all scores at all time points compared with presurgery levels (P < .05). The subjective IKDC score improved from median 40.4 preoperatively to 74.7 at 10-year follow-up (n = 13 patients; P < .05).
MACT is an excellent surgical therapy for full-thickness cartilage defects of the knee, with good long-term results for simple defects. However, it should not be used in salvage cases.
基质相关自体软骨细胞移植（MACT）已成为一种成熟的关节软骨修复技术。它能提供良好的短期和中期效果；然而，长期效果尚缺乏相关研究。
前瞻性评估膝关节MACT术后的临床结果，以报告长期疗效。
病例系列研究；证据等级，4级。
2000年至2006年间，53名受试者（女性/男性，22/31；平均年龄，32±12岁）接受了基于透明质酸的MACT产品治疗，并进行了前瞻性随访。平均体重指数（BMI）为24.5±3.8kg/m²，平均缺损面积为4.4±1.9cm²。50例为单处缺损，3例为多处缺损（41例位于股骨内侧髁，6例位于股骨外侧髁，2例位于髌骨，1例位于胫骨）。2例患者有2处缺损（股骨内侧髁/股骨外侧髁和胫骨/股骨内侧髁），1例患者的股骨内侧髁多处缺损接受了治疗。患者被分为23例“简单”病例、22例“复杂”病例和8例“挽救”病例。在移植植入前或植入时对不稳定或对线不良进行了治疗。对于6例小缺损（<2cm²）患者，在MACT前将微骨折作为一线治疗方法。每年进行一次临床评估，采用主观和客观的国际膝关节文献委员会（IKDC）评分、Lysholm评分和改良的辛辛那提膝关节评分系统。
平均随访时间为9.07±2.9年（范围，5 - 12年）。53例中有12例（22.6%）治疗失败，平均发生在术后2.99±1.40年。简单病例中有1例失败（4.3%），复杂病例中有4例失败（18.2%），挽救病例中有7例失败（87.5%）。与术前水平相比，所有时间点的所有评分均有统计学显著提高（P <.05）。主观IKDC评分从术前中位数40.4提高到10年随访时的74.7（n = 13例患者；P <.05）。
MACT是治疗膝关节全层软骨缺损的一种优秀手术方法，对简单缺损有良好的长期效果。然而，它不适用于挽救病例。
