Ross Andrew W, Murawski Christopher D, Fraser Ethan J, Ross Keir A, Do Huong T, Deyer Timothy W, Kennedy John G
Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, New York, U.S.A.
Department of Orthopedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, New York, New York, U.S.A..
Arthroscopy. 2016 Jul;32(7):1377-83. doi: 10.1016/j.arthro.2016.01.036. Epub 2016 Apr 6.
To determine if functional outcomes and magnetic resonance imaging (MRI) outcomes were significantly different between patients receiving primary autologous osteochondral transplantation (AOT) and patients receiving secondary AOT surgery after failed microfracture.
A group of 76 patients enrolled into the Foot and Ankle Service between 2006 and 2012 was retrospectively analyzed. Patient-reported outcomes were evaluated in 76 patients using the Foot and Ankle Outcome Score (FAOS). Superficial and deep tissues at the repaired defect site, as well as the adjacent normal cartilage, were analyzed using quantitative T2 mapping MRI. Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) allowed for morphological evaluation of the repair tissue. The mean clinical follow-up time was 51 ± 23 months (range, 12 to 97 months), and the mean MRI follow-up time was 26 months (range, 24 to 36 months).
Twenty-two patients received primary AOT and 54 received secondary AOT after failed microfracture. Patient characteristics between groups were similar with regard to age, gender, lesion size, and follow-up time. The mean postoperative FAOS was 10 points higher in the primary AOT group (83.2 ± 17.0) compared with the secondary AOT group (72.4 ± 19.4) (P = .01). Regression analysis showed that secondary AOT patients preoperative to postoperative change in FAOS was 9 points lower than in primary AOT patients after adjustment for age, preoperative FAOS, and lesion size (P = .045). The mean MOCART score, superficial T2 and deep T2 values, and the difference between normal and repair cartilage T2 values were not significantly different between groups. Lesion size was negatively correlated with MOCART scores (ρ = -0.2, P = .04), but positively correlated with difference in T2 values between repair and adjacent normal cartilage in the superficial layer (ρ = 0.3, P = .045).
Primary AOT shows better functional outcomes compared with secondary AOT after failed microfracture in patients with similar characteristics and lesion size. No significant differences in T2 mapping relaxation times and MOCART scores were identified.
Level III, case control study.
确定接受初次自体骨软骨移植（AOT）的患者与微骨折失败后接受二次AOT手术的患者之间的功能结局和磁共振成像（MRI）结局是否存在显著差异。
回顾性分析2006年至2012年期间纳入足踝科的76例患者。使用足踝结局评分（FAOS）对76例患者的患者报告结局进行评估。使用定量T2映射MRI分析修复缺损部位的浅表和深部组织以及相邻的正常软骨。磁共振软骨修复组织观察（MOCART）用于对修复组织进行形态学评估。临床平均随访时间为51±23个月（范围12至97个月），MRI平均随访时间为26个月（范围24至36个月）。
22例患者接受初次AOT，54例患者在微骨折失败后接受二次AOT。两组患者在年龄、性别、病变大小和随访时间方面的特征相似。初次AOT组术后平均FAOS（83.2±17.0）比二次AOT组（72.4±19.4）高10分（P = .01）。回归分析显示，在调整年龄、术前FAOS和病变大小后，二次AOT患者术前至术后FAOS的变化比初次AOT患者低9分（P = .045）。两组之间的平均MOCART评分、浅表T2和深部T2值以及正常软骨与修复软骨T2值之间的差异无显著统计学意义。病变大小与MOCART评分呈负相关（ρ = -0.2，P = .04），但与浅表层修复软骨与相邻正常软骨之间T2值的差异呈正相关（ρ = 0.3，P = .045）。
在具有相似特征和病变大小的患者中，初次AOT与微骨折失败后的二次AOT相比，显示出更好的功能结局。在T2映射弛豫时间和MOCART评分方面未发现显著差异。
III级，病例对照研究。
