Yabumoto Hiromitsu, Nakagawa Yasuaki, Mukai Shogo, Saji Takahiko
Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Knee. 2017 Dec;24(6):1498-1503. doi: 10.1016/j.knee.2017.07.016. Epub 2017 Sep 30.
The purpose of this retrospective study was to evaluate clinical outcomes of osteochondral autograft transplantation (OAT) for isolated patellofemoral (PF) osteoarthritis (OA).
OAT was performed in seven patients (six men, one woman; mean age, 61.1years) with isolated PF OA. The mean duration of follow up was 46.9months (range, 24-84months). Clinical outcomes were evaluated preoperatively and postoperatively according to the International Knee Documentation Committee (IKDC) objective score and the knee scoring system of the Japanese Orthopaedic Association (JOA) score. The International Cartilage Repair Society (ICRS) score was recorded in three cases that underwent second-look arthroscopies postoperatively. For morphological evaluation, the Kellgren and Lawrence (KL) classification and the modified magnetic resonance observation of cartilage repair tissue (MOCART) score were used.
The mean IKDC and JOA scores were both significantly improved. The percentage of normal and nearly normal on the IKDC score was increased from 28.6% (2/7) to 85.7% (6/7) (P=0.05). The mean JOA score was improved from 80.0 (range, 65.0-85.0) to 95.0 (range, 90.0-100) (P=0.0008). The mean ICRS scores were 10.3 (nearly normal) in the three cases that underwent second-look arthroscopies postoperatively. Regarding KL classification, the grade was unchanged in five cases (two cases in grade 1, three cases in grade 2) and improved in two cases (from grade 3 to 2, from grade 4 to 3). The mean modified MOCART score was 67.9 (range, 60.0-75) at 12-month follow up. There were no complications, and satisfaction was obtained in all cases. The study design was case series: level IV.
All clinical scores improved significantly postoperatively. Osteochondral plugs were transplanted perpendicular to the articular surface to obtain good congruity of the repaired articular surface. In this way, OAT is an effective procedure to prevent progression of isolated PF OA.
本回顾性研究的目的是评估自体骨软骨移植术（OAT）治疗单纯髌股关节（PF）骨关节炎（OA）的临床疗效。
对7例（6例男性，1例女性；平均年龄61.1岁）单纯PF OA患者进行OAT。平均随访时间为46.9个月（范围24 - 84个月）。术前和术后根据国际膝关节文献委员会（IKDC）客观评分和日本骨科协会（JOA）膝关节评分系统评估临床疗效。对3例术后接受二次关节镜检查的病例记录国际软骨修复协会（ICRS）评分。形态学评估采用Kellgren和Lawrence（KL）分级以及改良的软骨修复组织磁共振观察（MOCART）评分。
IKDC和JOA平均评分均显著提高。IKDC评分中正常和接近正常的比例从28.6%（2/7）增至85.7%（6/7）（P = 0.05）。JOA平均评分从术前的80.0（范围65.0 - 85.0）提高到95.0（范围90.0 - 100）（P = 0.0008）。3例术后接受二次关节镜检查的病例ICRS平均评分为10.3（接近正常）。KL分级方面，5例（1级2例，2级3例）分级未变，2例改善（从3级降至2级，从4级降至3级）。随访12个月时改良MOCART平均评分为67.9（范围60.0 - 75）。无并发症发生，所有病例均获得满意效果。本研究设计为病例系列：IV级。
术后所有临床评分均显著改善。将骨软骨栓垂直于关节面移植以获得修复关节面的良好匹配。通过这种方式，OAT是预防单纯PF OA进展的有效方法。
