Ebert Jay R, Smith Anne, Fallon Michael, Wood David J, Ackland Timothy R
School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Australia
School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia.
Am J Sports Med. 2014 Aug;42(8):1857-64. doi: 10.1177/0363546514534942. Epub 2014 Jun 2.
Matrix-induced autologous chondrocyte implantation (MACI) is an established technique for the repair of knee chondral defects, although the correlation between clinical and radiological outcomes after surgery is poorly understood.
To determine the correlation between clinical and radiological outcomes throughout the postoperative timeline to 5 years after MACI.
Cohort study (diagnosis); Level of evidence, 3.
This retrospective study was undertaken in 83 patients (53 male, 30 female) with complete clinical and radiological follow-up at 1, 2, and 5 years after MACI. The mean age of patients was 38.9 years (range, 13-62 years), with a mean body mass index (BMI) of 26.6 kg/m(2) (range, 16.8-34.8 kg/m(2)), mean defect size of 3.3 cm(2) (range, 1-9 cm(2)), and mean preoperative duration of symptoms of 9.2 years (range, 1-46 years). Patients indicated for MACI in this follow-up were 13 to 65 years of age, although they were excluded if they had a BMI >35 kg/m(2), had undergone prior extensive meniscectomy, or had ongoing progressive inflammatory arthritis. Patients were assessed clinically using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Magnetic resonance imaging (MRI) was used to evaluate the graft using a 1.5-T or 3-T clinical scanner; the MRI assessment included 8 parameters of graft repair (infill, signal intensity, border integration, surface contour, structure, subchondral lamina, subchondral bone, and effusion) based on the magnetic resonance observation of cartilage repair tissue (MOCART) score as well as an MRI composite score. The degree of an association between the MRI parameters and the KOOS subscales at each postoperative time point was assessed with the Spearman correlation coefficient (SCC), and significance was determined at P < .05. Ethics approval was obtained from the appropriate hospital and university Human Research Ethics Committees, and informed consent was gathered from all patients.
The only MRI parameter displaying consistent evidence of an association with the KOOS subscales was effusion, with a pattern of increasing strength of correlations over time and statistically significant associations at 5 years with KOOS-Pain (SCC, 0.25; P = .020), KOOS-Activities of Daily Living (SCC, 0.26; P = .018), and KOOS-Sport (SCC, 0.32; P = .003). Apart from a significant correlation between subchondral lamina and KOOS-Sport at 1 year (SCC, 0.27; P = .016), no further significant findings were observed.
Apart from some consistent evidence of an association between the KOOS and effusion, this analysis demonstrated a limited correlative capacity between clinical and radiological outcomes up to 5 years after surgery.
基质诱导自体软骨细胞植入术（MACI）是一种用于修复膝关节软骨缺损的成熟技术，尽管术后临床和影像学结果之间的相关性尚不清楚。
确定MACI术后至5年整个随访期内临床和影像学结果之间的相关性。
队列研究（诊断）；证据等级，3级。
本回顾性研究纳入了83例患者（53例男性，30例女性），这些患者在MACI术后1年、2年和5年有完整的临床和影像学随访资料。患者的平均年龄为38.9岁（范围13 - 62岁），平均体重指数（BMI）为26.6 kg/m²（范围16.8 - 34.8 kg/m²），平均缺损面积为3.3 cm²（范围1 - 9 cm²），术前症状平均持续时间为9.2年（范围1 - 46年）。本次随访中符合MACI指征的患者年龄在13至65岁之间，但如果BMI>35 kg/m²、既往接受过广泛半月板切除术或患有进行性炎性关节炎则被排除。使用膝关节损伤和骨关节炎疗效评分（KOOS）对患者进行临床评估。使用1.5-T或3-T临床扫描仪通过磁共振成像（MRI）评估移植物；MRI评估基于软骨修复组织磁共振观察（MOCART）评分以及MRI综合评分，包括移植物修复的8个参数（填充、信号强度、边界整合、表面轮廓、结构、软骨下板层、软骨下骨和积液）。使用Spearman相关系数（SCC）评估每个术后时间点MRI参数与KOOS子量表之间的关联程度，P <.05为有统计学意义。获得了相应医院和大学人类研究伦理委员会的伦理批准，并收集了所有患者的知情同意书。
唯一显示与KOOS子量表有一致关联证据的MRI参数是积液，其相关性强度随时间增加，在5年时与KOOS - 疼痛（SCC，0.25；P = 0.020）、KOOS - 日常生活活动（SCC，0.26；P = 0.018）和KOOS - 运动（SCC，0.32；P = 0.
