Erzincan University Faculty of Medicine, Basbaglar mahallesi No 1, 24030, Erzincan, Turkey.
Mengucekgazi Education and Research Hospital, Erzincan, Turkey.
Knee Surg Sports Traumatol Arthrosc. 2019 Mar;27(3):773-781. doi: 10.1007/s00167-018-5079-z. Epub 2018 Aug 1.
To determine the clinical and radiographic efficacy of chitosan-glycerol phosphate/blood implant versus hyaluronic acid-based cell-free scaffold in patients with focal osteochondral lesion of the knee joint.
Clinical data of 46 patients surgically treated using either chitosan-glycerol phosphate/blood implant (25 patients, Group 1) or hyaluronic acid-based cell-free scaffold (21 patients, Group 2) in combination with microfracture were retrospectively evaluated. All lesions were Outerbridge grade III or IV with a mean lesion size of 3.3 ± 0.7 cm. The mean follow-up time was 24.4 months. Visual analogue scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue.
No significant differences were detected between the groups regarding VAS, Lysholm, and Tegner scores at any time interval during the whole follow-up. The mean post-operative VAS and Lysholm scores at the latest follow-up was significantly better in cases with the lesion size ≤ 3 cm in Group 1 (p = 0.001, p < 0.001, respectively). However, no significant differences according to the lesion size were detected in Group 2 (n.s.). Complete repair with the filling of the defect was achieved in 7 (28%) of the knees in Group 1 and it was 7 (33.3%) of the knees in Group 2 according to MOCART system at the latest follow-up.
Single-stage regenerative cartilage surgery using chitosan-glycerol phosphate/blood implant combined to microfracture for focal osteochondral lesions of the knee revealed similar clinical and radiographic outcomes with hyaluronic acid-based cell-free scaffold at short-term follow-up. However, clinical outcomes of hyaluronan scaffold were less sensitive to defect size than chitosan. With the advantages of no hypertrophic repair tissue formation as well as no need to arthrotomy during surgery, chitosan is an effective choice especially in patients with the lesion size ≤ 3 cm.
III.
比较壳聚糖-甘油磷酸/血植入物与基于透明质酸的无细胞支架在膝关节局灶性骨软骨病变患者中的临床和影像学疗效。
回顾性分析了 46 例接受壳聚糖-甘油磷酸/血植入物（25 例，1 组）或基于透明质酸的无细胞支架（21 例，2 组）联合微骨折治疗的患者的临床资料。所有病变均为 Outerbridge Ⅲ或Ⅳ级，平均病变大小为 3.3±0.7cm。平均随访时间为 24.4 个月。视觉模拟评分（VAS）、Lysholm 膝关节评分和 Tegner 活动量表是评估临床状况的工具。磁共振软骨修复组织观察（MOCART）系统用于分析修复组织的特征。
在整个随访期间，两组在任何时间间隔的 VAS、Lysholm 和 Tegner 评分均无显著差异。在 1 组中，病变大小≤3cm 的病例术后 VAS 和 Lysholm 评分的平均末次随访明显更好（p=0.001，p<0.001）。然而，2 组中未发现病变大小的差异有统计学意义（n.s.）。1 组中，根据 MOCART 系统，7 例（28%）膝关节完全修复，缺陷完全填充；2 组中，7 例（33.3%）膝关节完全修复。
对于膝关节局灶性骨软骨病变，采用壳聚糖-甘油磷酸/血植入物联合微骨折的单阶段再生软骨手术，短期内与基于透明质酸的无细胞支架的临床和影像学结果相似。然而，透明质酸支架的临床结果对病变大小的敏感性不如壳聚糖。壳聚糖无肥厚修复组织形成的优点，且手术过程中无需关节切开术，因此对于病变大小≤3cm 的患者是一种有效的选择。
III。
