Berruto M, Ferrua P, Pasqualotto S, Uboldi F, Maione A, Tradati D, Usellini E
SSD Chirurgia Articolare del Ginocchio, Istituto Ortopedico Gaetano Pini, Milan, Italy.
SSD Chirurgia Articolare del Ginocchio, Istituto Ortopedico Gaetano Pini, Milan, Italy.
Injury. 2017 Oct;48(10):2230-2234. doi: 10.1016/j.injury.2017.08.005. Epub 2017 Aug 4.
Autologous Chondrocyte Implantation (ACI) has been the first technique in reconstruction of a valid articular surface. The aim of this study was to evaluate clinical results of this technique at an average follow up of 162±27months (range 88-208) in a group of patients who underwent ACI.
32 patients were operated between 1997 and 2007 for chondral lesions or osteochondritis dissecans of the knee. Mean size of the defect was 5.48cm±1.53 (range 2-9). Nine patients were treated with I generation technique and 23 with II generation. All patients were evaluated with Subjective IKDC and Tegner Activity Scales for clinical outcomes and with EQ-VAS for a quantitative measure of health after intervention, starting from pre-operative period and at regular follow up (minimum 88 months-maximum 208 months).
A significant increment of all scores was noticed comparing preoperative and postoperative results. In particular medium IKDC score increased from 40.3±9.6 in preoperative evaluation to 74.2±11.6 at one year (p<0.00001) and to 83.9±10.4 at 5 years follow up (p<0.001). Mean IKDC values at the last follow-up were 80.3±14.2, showing no statistical differences with those obtained at five-year follow-up. Tegner Activity Scale values increased from 2.8±1.1 preoperatively to 4.1±1.1 (p<0.0001) after one year and to 6±1.1 at five years (p<0.0001). Mean Tegner Activity Scale values decreased to 4.8±1.4 at the last follow-up. EQ-VAS evaluation showed superposable results comparing the 5 years evaluation with the ones at a medium follow up of 162±27months.
The most important finding is the reliability at long-term of ACI technique, which in our series gave excellent clinical results. No statistical differences were observed between first- and second-generation. Clinical outcomes were significantly better for defects in the femoral condyles, influenced by age (worse results over 30 years old).
ACI represents a valid technique for chondral and osteochondral lesions of the knee in a population heterogeneous for age, sex and activity level with good results even at a long term follow up.
自体软骨细胞移植（ACI）一直是重建有效关节面的首要技术。本研究的目的是评估一组接受 ACI 治疗的患者在平均随访 162±27 个月（范围 88 - 208 个月）时该技术的临床效果。
1997 年至 2007 年间，32 例患者因膝关节软骨损伤或剥脱性骨软骨炎接受手术。缺损的平均大小为 5.48cm±1.53（范围 2 - 9）。9 例患者采用第一代技术治疗，23 例采用第二代技术。从术前开始并在定期随访（最短 88 个月 - 最长 208 个月）时，所有患者均使用主观 IKDC 和 Tegner 活动量表评估临床结果，并使用 EQ - VAS 对干预后的健康状况进行定量测量。
比较术前和术后结果，所有评分均有显著提高。特别是 IKDC 平均评分从术前评估的 40.3±9.6 提高到 1 年时的 74.2±11.6（p<0.00001），5 年随访时提高到 83.9±10.4（p<0.001）。最后一次随访时 IKDC 的平均值得分为 80.3±14.2，与 5 年随访时获得的结果无统计学差异。Tegner 活动量表值从术前的 2.8±1.1 提高到 1 年后的 4.1±1.1（p<0.0001），5 年时提高到 6±1.1（p<0.0001）。最后一次随访时 Tegner 活动量表的平均值得分为 4.8±1.4。EQ - VAS 评估显示，将 5 年评估结果与 162±27 个月的中期随访结果进行比较，结果相当。
最重要的发现是 ACI 技术的长期可靠性，在我们的系列研究中取得了优异的临床效果。第一代和第二代之间未观察到统计学差异。股骨髁缺损的临床结果明显更好，受年龄影响（30 岁以上结果较差）。
ACI 是一种适用于膝关节软骨和骨软骨损伤患者的有效技术，这些患者在年龄、性别和活动水平方面存在异质性，即使在长期随访中也能取得良好效果。
