Shive M S, Restrepo A, Totterman S, Tamez-Peña J, Schreyer E, Steinwachs M, Stanish W D
Piramal Healthcare (Canada) Ltd, Canada.
Piramal Healthcare (Canada) Ltd, Canada.
Osteoarthritis Cartilage. 2014 Jun;22(6):800-4. doi: 10.1016/j.joca.2014.03.020. Epub 2014 Apr 12.
Intra-lesional bony overgrowth (BO) identified during or following cartilage repair treatment is being frequently described through subjective reports focusing primarily on incidence. Our objective was to quantify the exact volume of intra-lesional BO at 12 months post-cartilage repair treatment, to determine if a correlation exists between the extent of BO and clinical outcomes, and to visualize and characterize the BO.
MRI scans were systematically obtained during a randomized clinical trial for cartilage repair (Stanish et al., 2013) that compared two microfracture-based treatments in 78 patients. Semi-automated morphological segmentation of pre-treatment, 1 and 12 months post-treatment scans utilizing a programmed anatomical atlas for all knee bone and cartilage structures permitted three-dimensional reconstruction, quantitative analysis, as well as qualitative characterization and artistic visualization of BO.
Limited intra-lesional BO representing only 5.8 ± 5.7% of the original debrided cartilage lesion volume was found in 78 patients with available MRIs at 12 months. The majority (80%) of patients had very little BO (<10%). Most occurrences of BO carried either spotty (56.4%) or planar (6.4%) morphological features, and the remaining balance (37.2%) was qualitatively unobservable by eye. Pre-existing BO recurred at 12 months in the same intra-lesional location in 36% of patients. No statistical correlations were found between BO and clinical outcomes.
Intra-lesional BO following microfracture-based treatments may not be as severe as previously believed, its incidence is partly explained by pre-existing conditions, and no relationship to clinical outcomes exists at 12 months. Morphologically, observable BO was categorized as comprising either spotty or planar bone.
在软骨修复治疗期间或之后发现的病灶内骨过度生长（BO），目前主要通过侧重于发病率的主观报告进行描述。我们的目的是量化软骨修复治疗后12个月时病灶内BO的精确体积，确定BO的程度与临床结果之间是否存在相关性，并对BO进行可视化和特征描述。
在一项软骨修复的随机临床试验（Stanish等人，2013年）中，系统地获取了78例患者的MRI扫描图像，该试验比较了两种基于微骨折的治疗方法。利用针对所有膝关节骨骼和软骨结构的程序化解剖图谱，对治疗前、治疗后1个月和12个月的扫描图像进行半自动形态学分割，从而实现三维重建、定量分析以及对BO的定性特征描述和艺术可视化。
在78例12个月时有可用MRI的患者中，发现病灶内BO有限，仅占原始清创软骨损伤体积的5.8±5.7%。大多数（80%）患者的BO很少（<10%）。BO的大多数情况具有斑点状（56.4%）或平面状（6.4%）形态特征，其余（37.2%）在肉眼定性观察中无法察觉。36%的患者在12个月时，先前存在的BO在相同的病灶内位置复发。未发现BO与临床结果之间存在统计学相关性。
基于微骨折的治疗后病灶内BO可能不像之前认为的那么严重，其发生率部分由先前存在的情况所解释，并且在12个月时与临床结果无关。在形态学上，可观察到的BO被分类为斑点状或平面状骨。
