Yonetani Yasukazu, Tanaka Yoshinari, Kanamoto Takashi, Nakamura Norimasa, Nakata Ken, Horibe Shuji
Department of Orthopedic Sports Medicine, Hoshigaoka Koseinenkin Hospital, 4-8-1 Hoshigaoka, Hirakata, Osaka 573-8511, Japan.
Department of Sports Orthopaedics, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka 591-8025, Japan.
J Orthop Case Rep. 2019 Jan-Feb;9(1):53-57. doi: 10.13107/jocr.2250-0685.1306.
Autologous osteochondral transplantation (AOT) in the focal cartilage lesion of the patella has been reported with less successful results compared with other sites. The purposes were to investigate the clinical outcomes of AOT for focal patellar chondral lesion without patellofemoral instability.
Between 2001 and 2007, six patients (five males and one female) with a focal patellar cartilage lesion without patellofemoral malalignment and instability were treated with AOT. The mean age was 38 (27-51) years. Intraoperatively, the size and location of lesion were assessed by international cartilage repair society classification. Lysholm score was investigated preoperatively, at 6 months, 1- and 2-year, and final follow-up. Mean follow-up period was 51 months (24-101). Transplanted grafts were evaluated by magnetic resonance imaging (MRI) and second-look arthroscopy.
The mean size was 133mm2(78-225). All six cases improved at final follow-up (Lysholm score 79-100). Although immediate pain relief obtained in four cases, severe pain was persistent in remaining two cases during the 1styear and gradually relieved by 2 years following surgery. The size of these two cases was significantly larger (over 170 mm2) than that of four cases (100 mm2 in average) (P<0.05), and their locations were apart from center of the patella inspite of four cases localized centrally (P<0.05). Repaired cartilage did not show any difference by MRI and arthroscopically.
AOT in focal patellar chondral lesions without patellofemoral malalignment showed excellent results. In cases of large off-centeredlesions, however, it took longer for pain relief following AOT.
据报道，与其他部位相比，自体骨软骨移植（AOT）治疗髌骨局灶性软骨损伤的成功率较低。本研究旨在探讨AOT治疗无髌股关节不稳的髌骨局灶性软骨损伤的临床疗效。
2001年至2007年期间，对6例（5例男性，1例女性）无髌股关节排列不齐和不稳的髌骨局灶性软骨损伤患者进行了AOT治疗。平均年龄为38岁（27 - 51岁）。术中，根据国际软骨修复协会分类评估损伤的大小和位置。术前、术后6个月、1年和2年以及末次随访时调查Lysholm评分。平均随访期为51个月（24 - 101个月）。通过磁共振成像（MRI）和二次关节镜检查评估移植的移植物。
平均大小为133mm²（78 - 225mm²）。所有6例患者在末次随访时均有改善（Lysholm评分79 - 100）。虽然4例患者术后立即疼痛缓解，但其余2例患者在第1年持续存在严重疼痛，术后2年逐渐缓解。这2例患者的损伤面积明显大于4例患者（平均100mm²）（超过170mm²）（P < 0.05），且其位置偏离髌骨中心，而4例患者的损伤位于髌骨中央（P < 0.05）。修复后的软骨在MRI和关节镜检查中未显示出任何差异。
AOT治疗无髌股关节排列不齐的髌骨局灶性软骨损伤效果良好。然而，对于较大的偏心损伤病例，AOT后疼痛缓解所需时间较长。
