Ebert Jay R, Schneider Adrian, Fallon Michael, Wood David J, Janes Gregory C
School of Human Sciences, University of Western Australia, Crawley, Perth, Western Australia, Australia.
Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia.
Am J Sports Med. 2017 Dec;45(14):3243-3253. doi: 10.1177/0363546517724761. Epub 2017 Sep 14.
Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging clinical results in the treatment of knee chondral defects. However, earlier studies suggested that chondrocyte implantation in the patellofemoral (PF) joint was less effective than in the tibiofemoral (TF) joint.
To compare the radiological and clinical outcomes of those undergoing MACI to either the femoral condyles or PF joint.
Cohort study; Level of evidence, 3.
A total of 194 patients were included in this analysis, including 127 undergoing MACI to the medial (n = 94) and lateral (n = 33) femoral condyle, as well as 67 to the patella (n = 35) or trochlea (n = 32). All patients were evaluated clinically (Knee injury and Osteoarthritis Outcome Score [KOOS], visual analog scale, Short Form-36) before surgery and at 3, 12, and 24 months after surgery, while magnetic resonance imaging (MRI) was undertaken at 3, 12, and 24 months, with the MOCART (magnetic resonance observation of cartilage repair tissue) scoring system employed to evaluate the quality and quantity of repair tissue, as well as an MRI composite score. Patient satisfaction was evaluated.
No significant group differences ( P > .05) were seen in demographics, defect size, prior injury, or surgical history, while the majority of clinical scores were similar preoperatively. All clinical scores significantly improved over time ( P < .05), with a significant group effect observed for KOOS activities of daily living ( P = .008), quality of life ( P = .008), and sport ( P = .017), reflecting better postoperative scores in the TF group. While the PF group had significantly lower values at baseline for the KOOS activities of daily living and quality of life subscales, it actually displayed a similar net improvement over time compared with the TF group. At 24 months, 93.7% (n = 119) and 91.0% (n = 61) of patients were satisfied with the ability of MACI to relieve their knee pain, 74.0% (n = 94) and 65.7% (n = 44) with their ability to participate in sport, and 90.5% (n = 115) and 83.6% (n = 56) satisfied overall, in the TF and PF groups, respectively. MRI evaluation via the MOCART score revealed a significant time effect ( P < .05) for the MRI composite score and graft infill over the 24-month period. While subchondral lamina scored significantly better ( P = .002) in the TF group, subchondral bone scored significantly worse ( P < .001). At 24 months, the overall MRI composite score was classified as good/excellent in 98 TF patients (77%) and 54 PF patients (81%).
MACI in the PF joint with concurrent correction of PF maltracking if required leads to similar clinical and radiological outcomes compared with MACI on the femoral condyles.
基质诱导自体软骨细胞植入术（MACI）在治疗膝关节软骨缺损方面已显示出令人鼓舞的临床效果。然而，早期研究表明，在髌股（PF）关节植入软骨细胞的效果不如在胫股（TF）关节。
比较接受MACI治疗股骨髁或PF关节患者的影像学和临床结果。
队列研究；证据等级，3级。
本分析共纳入194例患者，其中127例接受内侧（n = 94）和外侧（n = 33）股骨髁的MACI治疗，67例接受髌骨（n = 35）或滑车（n = 32）的MACI治疗。所有患者在手术前以及术后3、12和24个月进行临床评估（膝关节损伤和骨关节炎疗效评分[KOOS]、视觉模拟量表、简明健康状况调查量表），同时在术后3、12和24个月进行磁共振成像（MRI）检查，采用MOCART（软骨修复组织磁共振观察）评分系统评估修复组织的质量和数量以及MRI综合评分。评估患者满意度。
在人口统计学、缺损大小、既往损伤或手术史方面未观察到显著的组间差异（P > 0.05），而大多数临床评分在术前相似。所有临床评分随时间均显著改善（P < 0.05），在KOOS日常生活活动（P = 0.008）、生活质量（P = 0.008）和运动（P = 0.017）方面观察到显著的组效应，表明TF组术后评分更好。虽然PF组在KOOS日常生活活动和生活质量子量表的基线值显著较低，但与TF组相比，其随时间的净改善实际上相似。在24个月时，TF组和PF组分别有93.7%（n = 119）和91.0%（n = 61）的患者对MACI缓解膝关节疼痛的能力感到满意，74.0%（n = 94）和65.7%（n = 44）的患者对参与运动的能力感到满意，总体满意度分别为90.5%（n = 115）和83.6%（n = 56）。通过MOCART评分进行的MRI评估显示，在24个月期间，MRI综合评分和移植物填充有显著的时间效应（P < 0.05）。虽然TF组的软骨下板评分显著更好（P = 0.002），但软骨下骨评分显著更差（P < 0.001）。在24个月时，98例TF患者（77%）和54例PF患者（81%）的总体MRI综合评分被归类为良好/优秀。
与股骨髁的MACI相比，必要时对PF关节进行MACI并同时纠正PF轨迹不良，可导致相似的临床和影像学结果。
