Otaševič T, Vališ P, Rouchal M, Novák J, Repko M, Šprláková A, Krbec M
Ortopedická klinika, Fakultní nemocnice Brno.
Acta Chir Orthop Traumatol Cech. 2016;83(3):169-74.
PUPOSE OF THE STUDY The treatment of osteochondral lesions of weight-bearing joints remains a serious therapeutic challenge, largely due to the minimal ability of articular hyaline cartilage to regenerate. The authors present the long-term clinical and MRI results of treating deep chondral and osteochondral defects of the ankle joint by the method of implantation of autologous chondrocytes in the form of a solid chondrograft. MATERIAL AND METHODS The method of solid chondrograft implantation in the ankle joint was used in our Department from the year 2003. Between 2003 and 2013, this method was used in 31 patients, 16 men and 15 women. Their average age at the time of implantation was 29 years (16 to 50 years). The follow-up period ranged from 16 to 145 months (average, 57 months). The clinical outcome was evaluated using the Mazur questionnaire. At follow-up all patients underwent regular MRI examinations and the results were assessed on the basis of Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scores. Twelve patients required a second-look arthroscopy. RESULTS A comparison of the Mazur pre-operative scores with those obtained at 1, 2 and 5 years post-operatively showed marked improvement of ankle joint function. The average pre-operative value of 30.0 (based on responses of 31 patients) increased to the average of 89.7 (based on results of 11 patients). At 1 year post-operatively, the average MOCART score for a group of 18 patients was 78.3; at 5 post-operative years, the average value for nine patients examined was 77.0. Complete filling of defects at 1 year of follow-up was found in 88.1% and , at 5 years, it was recorded in 83.3% of the patients examined. DISCUSSION The articular hyaline cartilage is a highly differentiated tissue and its ability of repair is very limited. Therefore every damage to the articular surface should be regarded as a pre-arthritic condition// disease. Currently, there are several options of treating a damaged articular cartilage, but none of them makes its complete healing certain. A lot of studies concerned with longterm results of implanting autologous chondrocytes in the knee are available in the literature, but only few authors present long-term clinical and radiographic outcomes of ankle joint treatment similar to ours. CONCLUSIONS Based on our clinical and MRI results, the method of autologous chondrocyte implantation can be recommended since it has good long-term results, provides repair of articular cartilage and allows for patients' return to activities of daily living.
chondral defect, hyaline cartilage, autologous chondrocyte, ankle joint.
研究目的 负重关节骨软骨损伤的治疗仍然是一项严峻的治疗挑战，这主要是由于关节透明软骨的再生能力极小。作者介绍了通过植入自体软骨细胞形成实体软骨移植物的方法治疗踝关节深层软骨和骨软骨缺损的长期临床和MRI结果。材料与方法 自2003年起，我们科室采用实体软骨移植物植入踝关节的方法。2003年至2013年期间，该方法应用于31例患者，其中男性16例，女性15例。植入时他们的平均年龄为29岁（16至50岁）。随访期为16至145个月（平均57个月）。使用Mazur问卷评估临床结果。随访时所有患者均接受常规MRI检查，并根据软骨修复组织磁共振观察（MOCART）评分评估结果。12例患者需要二次关节镜检查。结果 将术前Mazur评分与术后1年、2年和5年获得的评分进行比较，结果显示踝关节功能有显著改善。术前平均评分为30.0（基于31例患者的回答），术后平均提高到89.7（基于11例患者的结果）。术后1年，18例患者的MOCART平均评分为78.3；术后5年，9例接受检查患者的平均值为77.0。随访1年时，88.1%的患者缺损完全填充，5年时，接受检查患者中有83.3%记录到缺损完全填充。讨论 关节透明软骨是一种高度分化的组织，其修复能力非常有限。因此，关节表面的每一次损伤都应被视为关节炎前期状况/疾病。目前，有几种治疗受损关节软骨的方法，但没有一种能确保其完全愈合。文献中有许多关于在膝关节植入自体软骨细胞长期结果的研究，但只有少数作者展示了与我们类似的踝关节治疗的长期临床和影像学结果。结论 根据我们的临床和MRI结果，自体软骨细胞植入方法值得推荐，因为它具有良好的长期效果，能修复关节软骨并使患者恢复日常生活活动。关键词：软骨缺损；透明软骨；自体软骨细胞；踝关节
