Vangsness C Thomas, Higgs Geoffrey, Hoffman James K, Farr Jack, Davidson Philip A, Milstein Farrell, Geraghty Sandra
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
Department of Orthopaedic Surgery and Sports Medicine, OrthoCare Institute, Lumin Health, Plano, Texas.
J Knee Surg. 2018 Jul;31(6):528-535. doi: 10.1055/s-0037-1604138. Epub 2017 Jul 24.
Restoration and repair of articular cartilage injuries remain a challenge for orthopaedic surgeons. The standard first-line treatment of articular cartilage lesions is marrow stimulation; however, this procedure can often result in the generation of fibrous repair cartilage rather than the biomechanically superior hyaline cartilage. Marrow stimulation is also often limited to smaller lesions, less than 2 cm. Larger lesions may require implantation of a fresh osteochondal allograft, though a short shelf life, size-matched donor requirements, potential challenges of bone healing, limited availability, and the relatively high price limit the wide use of this therapeutic approach. We present a straightforward, single-stage surgical technique of a novel reparative and restorative approach for articular cartilage repair with the implantation of a cryopreserved viable osteochondral allograft (CVOCA). The CVOCA contains full-thickness articular cartilage and a thin layer of subchondral bone, and maintains the intact native cartilage architecture with viable chondrocytes, growth factors, and extracellular matrix proteins to promote articular cartilage repair. We report the results of a retrospective case series of three patients who presented with articular cartilage lesions more than 2 cm and were treated with the CVOCA using the presented surgical technique. Patients were followed up to 2 years after implantation of the CVOCA and all three patients had satisfactory outcomes without adverse events. Controlled randomized studies are suggested for evaluation of CVOCA efficacy, safety, and long-term outcomes.
关节软骨损伤的修复和重建仍然是骨科医生面临的一项挑战。关节软骨损伤的标准一线治疗方法是骨髓刺激；然而，这种方法通常会导致纤维性修复软骨的生成，而非生物力学性能更优的透明软骨。骨髓刺激通常也仅限于小于2厘米的较小损伤。较大的损伤可能需要植入新鲜的骨软骨异体移植物，不过其保质期短、需要尺寸匹配的供体、存在骨愈合方面的潜在挑战、可用性有限以及价格相对较高，限制了这种治疗方法的广泛应用。我们介绍一种简单的单阶段手术技术，即通过植入冷冻保存的活性骨软骨异体移植物（CVOCA）对关节软骨修复采用一种新型的修复和重建方法。CVOCA包含全层关节软骨和一层薄薄的软骨下骨，并通过存活的软骨细胞、生长因子和细胞外基质蛋白维持完整的天然软骨结构，以促进关节软骨修复。我们报告了一个回顾性病例系列的结果，该系列中有三名患者，他们患有超过2厘米的关节软骨损伤，并采用所介绍的手术技术接受了CVOCA治疗。在植入CVOCA后对患者进行了长达2年的随访，所有三名患者均取得了满意的结果，且无不良事件发生。建议开展对照随机研究以评估CVOCA的疗效、安全性和长期结果。
