Ebert Jay R, Fallon Michael, Wood David J, Janes Gregory C
School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Australia.
Perth Radiological Clinic, Subiaco, Australia.
Am J Sports Med. 2017 Jan;45(1):59-69. doi: 10.1177/0363546516663493. Epub 2016 Oct 1.
While midterm outcomes after matrix-induced autologous chondrocyte implantation (MACI) are encouraging, the procedure permits an arthroscopic approach that may reduce the morbidity of arthrotomy and permit accelerated rehabilitation.
A significant improvement in clinical and radiological outcomes after arthroscopic MACI will exist through to 5 years after surgery.
Case series; Level of evidence, 4.
We prospectively evaluated the first 31 patients (15 male, 16 female) who underwent MACI via arthroscopic surgery to address symptomatic tibiofemoral chondral lesions. MACI was followed by a structured rehabilitation program in all patients. Clinical scores were administered preoperatively and at 3 and 6 months as well as 1, 2, and 5 years after surgery. These included the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee scale (LKS), Tegner activity scale (TAS), visual analog scale for pain, Short Form-36 Health Survey (SF-36), active knee motion, and 6-minute walk test. Isokinetic dynamometry was used to assess peak knee extension and flexion strength and limb symmetry indices (LSIs) between the operated and nonoperated limbs. High-resolution magnetic resonance imaging (MRI) was performed at 3 months and at 1, 2, and 5 years postoperatively to evaluate graft repair as well as calculate the MRI composite score.
There was a significant improvement ( P < .05) in all KOOS subscale scores, LKS and TAS scores, the SF-36 physical component score, pain frequency and severity, active knee flexion and extension, and 6-minute walk distance. Isokinetic knee extension strength significantly improved, and all knee extension and flexion LSIs were above 90% (apart from peak knee extension strength at 1 year). At 5 years, 93% of patients were satisfied with MACI to relieve their pain, 90% were satisfied with improving their ability to undertake daily activities, and 80% were satisfied with the improvement in participating in sport. Graft infill ( P = .033) and the MRI composite score ( P = .028) significantly improved over time, with 90% of patients demonstrating good to excellent tissue infill at 5 years. There were 2 graft failures at 5 years after surgery.
The arthroscopically performed MACI technique demonstrated good clinical and radiological outcomes up to 5 years, with high levels of patient satisfaction.
虽然基质诱导自体软骨细胞植入术（MACI）的中期结果令人鼓舞，但该手术允许采用关节镜入路，这可能会降低切开手术的发病率并允许加速康复。
关节镜下MACI术后至术后5年，临床和放射学结果将有显著改善。
病例系列；证据等级，4级。
我们前瞻性评估了首批31例（男15例，女16例）因症状性胫股关节软骨损伤接受关节镜下MACI手术的患者。所有患者在MACI术后均接受结构化康复计划。术前以及术后3个月、6个月、1年、2年和5年进行临床评分。这些评分包括膝关节损伤和骨关节炎结局评分（KOOS）、Lysholm膝关节评分（LKS）、Tegner活动评分（TAS）、疼痛视觉模拟评分、简短健康调查36项量表（SF-36）、膝关节主动活动度以及6分钟步行试验。采用等速测力计评估膝关节伸展和屈曲的峰值力量以及手术侧与非手术侧肢体的肢体对称指数（LSIs）。术后3个月、1年、2年和5年进行高分辨率磁共振成像（MRI）以评估移植物修复情况并计算MRI综合评分。
所有KOOS子量表评分、LKS和TAS评分、SF-36身体成分评分、疼痛频率和严重程度、膝关节主动屈伸度以及6分钟步行距离均有显著改善（P <.05）。等速膝关节伸展力量显著提高，所有膝关节伸展和屈曲LSIs均高于90%（1年时膝关节伸展峰值力量除外）。在5年时,93%的患者对MACI缓解疼痛感到满意，90%的患者对改善日常活动能力感到满意，80%的患者对参与运动的改善情况感到满意。移植物填充情况（P = 0.033）和MRI综合评分（P = 0.028）随时间显著改善，90%的患者在5年时显示组织填充良好至优秀。术后5年有2例移植物失败。
关节镜下MACI技术在长达5年的时间里显示出良好的临床和放射学结果，患者满意度高。
