Dugard M Naomi, Kuiper Jan Herman, Parker Jane, Roberts Sally, Robinson Eric, Harrison Paul, Richardson James B
1 Robert Jones & Agnes Hunt Orthopaedic NHS Foundation Trust Hospital, Oswestry, Shropshire, UK.
2 Institute of Science and Technology in Medicine, Keele University, Keele, Staffordshire, UK.
Cartilage. 2017 Apr;8(2):119-130. doi: 10.1177/1947603516650002. Epub 2016 Jul 8.
Objective The study had 2 objectives: first, to evaluate the success of autologous chondrocyte implantation (ACI) in terms of incidence of surgical re-intervention, including arthroplasty, and investigate predictors of successful treatment outcome. The second objective was to derive a tool predicting a patient's arthroplasty risk following ACI. Design In this Level II, prognostic study, 170 ACI-treated patients (110 males [aged 36.8 ± 9.4 years]; 60 females [aged 38.1 ± 10.2 years]) completed a questionnaire about further surgery on their knee treated with ACI 10.9 ± 3.5 years previously. Factors commonly assessed preoperatively (age, gender, defect location and number, previous surgery at this site, and the preoperative Lysholm score) were used as independent factors in regression analyses. Results At final follow-up (maximum of 19 years post-ACI), 40 patients (23.5%) had undergone surgical re-intervention following ACI. Twenty-six patients (15.3%) underwent arthroplasty, more commonly females (25%) than males (10%; P = 0.001). Cox regression analyses identified 4 factors associated with re-intervention: age at ACI, multiple operations before ACI, patellar defects, and lower pretreatment Lysholm scores (Nagelkerke's R = 0.20). Six predictive items associated with risk of arthroplasty following ACI (Nagelkerke's R = 0.34) were used to develop the Oswestry Risk of Knee Arthroplasty index with internal cross-validation. Conclusion In a single-center study, we have identified 6 factors (age, gender, location and number of defects, number of previous operations, and Lysholm score before ACI) that appear to influence the likelihood of ACI patients progressing to arthroplasty. We have used this information to propose a formula or "tool" that could aid treatment decisions and improve patient selection for ACI.
目的 本研究有两个目的：第一，根据包括关节置换术在内的手术再次干预发生率评估自体软骨细胞植入术（ACI）的成功率，并调查治疗成功结果的预测因素。第二个目的是得出一种预测ACI术后患者关节置换风险的工具。设计 在这项二级预后研究中，170例接受ACI治疗的患者（110例男性[年龄36.8±9.4岁]；60例女性[年龄38.1±10.2岁]）完成了一份关于其10.9±3.5年前接受ACI治疗的膝关节进一步手术情况的问卷。术前通常评估的因素（年龄、性别、缺损位置和数量、该部位既往手术情况以及术前Lysholm评分）在回归分析中用作独立因素。结果 在最终随访时（ACI术后最长19年），40例患者（23.5%）在ACI术后接受了手术再次干预。26例患者（15.3%）接受了关节置换术，女性（25%）比男性（10%）更常见（P = 0.001）。Cox回归分析确定了与再次干预相关的4个因素：ACI时的年龄、ACI前的多次手术、髌股关节缺损以及较低的治疗前Lysholm评分（Nagelkerke's R = 0.20）。使用与ACI术后关节置换风险相关的6个预测项目（Nagelkerke's R = 0.34）通过内部交叉验证制定了奥斯韦斯特里膝关节置换风险指数。结论 在一项单中心研究中，我们确定了6个因素（年龄、性别、缺损位置和数量、既往手术次数以及ACI前的Lysholm评分），这些因素似乎会影响ACI患者进展为关节置换术的可能性。我们利用这些信息提出了一个公式或“工具”。该公式或“工具”有助于治疗决策并改善ACI患者的选择。
