Enea D, Cecconi S, Calcagno S, Busilacchi A, Manzotti S, Gigante A
Department of Orthopedics, Polytechnic University of Marche, Via Tronto 10/A, 60020 Ancona, Italy.
Department of Orthopedics, Polytechnic University of Marche, Via Tronto 10/A, 60020 Ancona, Italy.
Knee. 2015 Jan;22(1):30-5. doi: 10.1016/j.knee.2014.10.003. Epub 2014 Nov 20.
Different single-stage surgical approaches are currently under evaluation to repair cartilage focal lesions. To date, only little is known on even short-term clinical follow-up and almost no knowledge exists on histological results of such treatments. The present paper aims to analyze the clinical and histological results of the collagen-covered microfracture and bone marrow concentrate (C-CMBMC) technique in the treatment of focal condylar lesions of knee articular cartilage.
Nine patients with focal lesions of the condylar articular cartilage were consecutively treated with arthroscopic microfractures (MFX) covered with a collagen membrane immersed in autologous bone marrow concentrate (BMC) from the iliac crest. Patients were retrospectively assessed using several standardized outcome assessment tools and MRI scans. Four patients consented to undergo second look arthroscopy and biopsy harvest.
Every patient was arthroscopically treated for a focal condylar lesion (mean area 2.5 SD(0.4) cm(2)). All the patients (mean age 43 SD(9) years) but one experienced a significant clinical improvement from the pre-operative condition to the latest follow-up (mean 29 SD(11) months). Cartilage macroscopic assessment at 12 months revealed that all the repairs appeared almost normal. Histological analysis showed a hyaline-like cartilage repair in one lesion, a fibrocartilaginous repair in two lesions and a mixture of both in one lesion.
The first clinical experience with single-stage C-CMBMC for focal cartilage defects in the knee suggests that it is safe, it improves the short-term knee function and that it has the potential to recreate hyaline-like cartilage.
目前正在评估不同的单阶段手术方法来修复软骨局灶性病变。迄今为止，即使是短期临床随访的相关信息也知之甚少，对于此类治疗的组织学结果几乎一无所知。本文旨在分析胶原覆盖微骨折联合骨髓浓缩物（C-CMBMC）技术治疗膝关节软骨局灶性髁部病变的临床和组织学结果。
连续9例膝关节髁部关节软骨局灶性病变患者接受关节镜下微骨折（MFX）治疗，并用浸有自体髂嵴骨髓浓缩物（BMC）的胶原膜覆盖。采用多种标准化结局评估工具和MRI扫描对患者进行回顾性评估。4例患者同意接受二次关节镜检查并获取活检样本。
每位患者均接受关节镜下治疗膝关节髁部局灶性病变（平均面积2.5 SD(0.4) cm²）。除1例患者外，所有患者（平均年龄43 SD(9)岁）从术前状态到最新随访（平均29 SD(11)个月）均有显著临床改善。12个月时的软骨宏观评估显示，所有修复均几乎正常。组织学分析显示，1个病变为透明软骨样修复，2个病变为纤维软骨修复，1个病变为两者混合修复。
单阶段C-CMBMC治疗膝关节局灶性软骨缺损的首次临床经验表明，该方法安全，可改善膝关节短期功能，并有潜力重建透明软骨样组织。
