DeSandis Bridget A, Haleem Amgad M, Sofka Carolyn M, O'Malley Martin J, Drakos Mark C
Research Assistant, Hospital for Special Surgery, New York, NY.
Assistant Professor, Department of Orthopedic Surgery, Oklahoma University, Oklahoma City, OK; Lecturer, Department of Orthopedic Surgery, Kasr Al-Ainy College of Medicine, Cairo University, Cairo, Egypt.
J Foot Ankle Surg. 2018 Mar-Apr;57(2):273-280. doi: 10.1053/j.jfas.2017.09.009. Epub 2018 Jan 2.
Juvenile allogenic chondrocyte implantation (JACI; DeNovo NT Natural Tissue Graft; Zimmer, Warsaw, IN) with autologous bone marrow aspirate concentrate (BMAC) is a relatively new all-arthroscopic procedure for treating critical-size osteochondral lesions (OCLs) of the talus. Few studies have investigated the clinical and radiographic outcomes of this procedure. We collected the clinical and radiographic outcomes of patients who had undergone JACI-BMAC for talar OCLs to assess treatment efficacy and cartilage repair tissue quality using magnetic resonance imaging (MRI). Forty-six patients with critical-size OCLs (≥6 mm widest diameter) received JACI-BMAC from 2012 to 2014. We performed a retrospective medical record review and assessed the functional outcomes pre- and postoperatively using the Foot and Ankle Outcome Score (FAOS) and Short-Form 12-item general health questionnaire. MRI was performed preoperatively and at 12 and 24 months postoperatively. Cartilage morphology was evaluated on postoperative MRI scans using the magnetic resonance observation of cartilage tissue (MOCART) score. The pre- to postoperative changes and relationships between outcomes and lesion size, bone grafting, lesion location, instability, hypertrophy, and MOCART scores were analyzed. Overall, the mean questionnaire scores improved significantly, with almost every FAOS subscale showing significant improvement postoperatively. Concurrent instability resulted in more changes that were statistically significant. The use of bone grafting and the presence of hypertrophy did not result in statistically significant changes in the outcomes. Factors associated with outcomes were lesion size and hypertrophy. Increasing lesion size was associated with decreased FAOS quality of life subscale and hypertrophy correlating with changes in the pain subscale. Of the 46 patients, 22 had undergone postoperative MRI scans that were scored. The average MOCART score was 46.8. Most patients demonstrated a persistent bone marrow edema pattern and hypertrophy of the reparative cartilage. Juvenile articular cartilage implantation of the DeNovo NT allograft and BMAC resulted in improved functional outcome scores; however, the reparative tissue still exhibited fibrocartilage composition radiographically. Further studies are needed to investigate the long-term outcomes and determine the superiority of the arthroscopic DeNovo procedure compared with microfracture and other cartilage resurfacing procedures.
青少年同种异体软骨细胞植入术（JACI；DeNovo NT天然组织移植物；Zimmer公司，印第安纳州华沙）联合自体骨髓浓缩液（BMAC）是一种相对较新的全关节镜手术，用于治疗距骨的临界尺寸骨软骨损伤（OCL）。很少有研究调查该手术的临床和影像学结果。我们收集了接受JACI - BMAC治疗距骨OCL患者的临床和影像学结果，以使用磁共振成像（MRI）评估治疗效果和软骨修复组织质量。2012年至2014年，46例临界尺寸OCL（最大直径≥6毫米）患者接受了JACI - BMAC治疗。我们进行了回顾性病历审查，并使用足踝结果评分（FAOS）和简短形式12项一般健康问卷评估术前和术后的功能结果。术前以及术后12个月和24个月进行了MRI检查。使用软骨组织磁共振观察（MOCART）评分对术后MRI扫描的软骨形态进行评估。分析了术前至术后的变化以及结果与病变大小、骨移植、病变位置、不稳定、肥大和MOCART评分之间的关系。总体而言，问卷平均得分显著提高，几乎每个FAOS子量表术后均显示出显著改善。并发不稳定导致更多具有统计学意义的变化。使用骨移植和肥大的存在并未导致结果有统计学意义的变化。与结果相关的因素是病变大小和肥大。病变大小增加与FAOS生活质量子量表降低相关，肥大与疼痛子量表的变化相关。46例患者中，22例进行了术后MRI扫描并评分。平均MOCART评分为46.8。大多数患者表现出持续的骨髓水肿模式和修复软骨肥大。DeNovo NT同种异体移植物和BMAC的青少年关节软骨植入术导致功能结果评分改善；然而，修复组织在影像学上仍表现为纤维软骨成分。需要进一步研究以调查长期结果，并确定关节镜下DeNovo手术与微骨折和其他软骨表面修复手术相比的优越性。
