Department of Neuroradiology, University Hospital of Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
Knee Surg Sports Traumatol Arthrosc. 2019 Sep;27(9):3001-3013. doi: 10.1007/s00167-018-5321-8. Epub 2018 Dec 12.
To investigate, whether cartilage repair surgery for focal osteochondral defects at the knee results in less degenerative changes over 6 years in a MR imaging follow-up than morphologically initially identical defects in non-operated control subjects from the osteoarthritis initiative (OAI).
A total of 32 individuals received baseline and follow-up MRI. In n = 16 patients with cartilage repair [osteochondral autograft transfer system (OATS), n = 12; spongiosa-augmented matrix-associated autologous chondrocyte implantation (MACI), n = 4] MRI was performed preoperatively and after 5.7 ± 2.3 year follow-up. Baseline MRIs of non-operated subjects from the OAI were screened for initially identical cartilage defects (n = 16). Morphological knee abnormalities were assessed using WORMS, AMADEUS and MOCART scores. A sagittal 2D MSME sequence was implemented for quantitative cartilage T2 relaxation time measurements in all (0, 2, 4, 6 and 8-years) follow-ups from the OAI and in the postoperative MRI protocol.
For both groups, focal osteochondral defects were located at the femoral condyle in 8/16 cases (5 medial, 3 lateral) and at the patella in 8/16 cases. At baseline, the mean cartilage defect size ± SD was 1.4 ± 1.3 cm for the control group and 1.3 ± 1.2 cm for the cartilage repair group (n.s.). WORMS scores were not significantly different between the cartilage repair group and the control group at baseline [mean difference ± SEM (95%CI); 0.5 ± 2.5 (- 4.7, 5.7), n.s.]. During identical follow-up times, the progression of total WORMS scores [19.9 ± 2.3 (15.0, 24.9), P < 0.001] and of cartilage defects scores in the affected (P < 0.001) and in the opposing (P = 0.029) compartment was significantly more severe in non-operated individuals (P < 0.05). In non-operated subjects, T2 values increased continuously from baseline to the 8-year follow-up (P = 0.001).
Patients with cartilage repair showed less progression of degenerative MRI changes at 6-year follow-up than a control cohort from the OAI with initially identical osteochondral defects. Patients with focal cartilage defects may profit from cartilage repair surgery since it may prevent progression of early osteoarthritis at the knee joint.
Prognostic study, Level II.
研究膝关节局灶性骨软骨缺损行软骨修复手术后，在磁共振成像（MRI）随访 6 年时，与骨关节炎倡议（OAI）中未经手术的对照患者中形态上最初相同的缺损相比，是否会导致较少的退行性变化。
共有 32 名患者接受了基线和随访 MRI 检查。在 n=16 名接受软骨修复的患者中[骨软骨自体移植系统（OATS），n=12；海绵骨增强基质相关自体软骨细胞植入（MACI），n=4]，术前和 5.7±2.3 年后进行了 MRI 检查。从 OAI 中筛选出未经手术的对照患者的基线 MRI，以寻找最初相同的软骨缺损（n=16）。使用 WORMS、AMADUES 和 MOCART 评分评估膝关节形态异常。在所有（0、2、4、6 和 8 年）OAI 随访和术后 MRI 方案中，实施矢状 2D MSME 序列对定量软骨 T2 弛豫时间进行测量。
两组的局灶性骨软骨缺损均位于股骨髁 8/16 例（5 例内侧，3 例外侧）和髌骨 8/16 例。在基线时，对照组的平均软骨缺损大小为 1.4±1.3cm，软骨修复组为 1.3±1.2cm（无统计学差异）。在基线时，软骨修复组和对照组的 WORMS 评分无显著差异[平均差值±SEM（95%CI）；0.5±2.5（-4.7，5.7），无统计学差异]。在相同的随访时间内，总 WORMS 评分的进展[19.9±2.3（15.0，24.9），P<0.001]以及患侧（P<0.001）和对侧（P=0.029）关节软骨缺损评分的进展在未手术患者中更为严重（P<0.05）。在未手术患者中，T2 值从基线到 8 年随访持续增加（P=0.001）。
在 6 年随访时，接受软骨修复的患者与 OAI 中具有最初相同的骨软骨缺损的对照组相比，退行性 MRI 变化的进展较少。患有局灶性软骨缺损的患者可能会从软骨修复手术中获益，因为它可能会阻止膝关节早期骨关节炎的进展。
预后研究，II 级。
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