Zikria Bashir, Hafezi-Nejad Nima, Patten Ian, Johnson Alex, Haj-Mirzaian Arya, Wilckens John H, Ficke James R, Demehri Shadpour
Department of Orthopaedic Surgery (B.Z, I.P., A.J., J.H.W., and J.R.F.) and Russell H. Morgan Department of Radiology (N.H.N., A.H.M., and S.D.), Johns Hopkins University, Baltimore, Maryland.
JB JS Open Access. 2019 May 29;4(2):e0039. doi: 10.2106/JBJS.OA.18.00039. eCollection 2019 Apr-Jun.
Autologous chondrocyte implantation (ACI), a promising modality for repairing full-thickness cartilage defects, requires 2 consecutive arthroscopic procedures for chondrocyte harvesting and implantation. In the present study, we assessed the feasibility and efficacy of image-guided chondrocyte harvesting as an alternative to arthroscopic biopsy.
We induced full-thickness cartilage defects in 10 human cadaveric knees. Computed tomographic arthrography (CTA) was performed following the intra-articular administration of Omnipaque 350 to measure the diameters of the induced cartilage defects. Subsequently, 2 independent operators conducted CTA-guided chondrocyte harvesting (from the medial and lateral trochlear ridges) in each knee. The time for chondrocyte harvesting, accuracy (distance between the predefined target on CTA and the final insertion site of the needle), and number of needle readjustments were recorded. In the institutional review board-approved clinical study, informed consent was obtained and chondrocyte harvesting was performed both with use of a conventional arthroscopic biopsy method and with use of a needle through an arthroscopy access site in 10 subjects for whom ACI was indicated. The samples were processed and cultured blindly, and the quantity and quality of the samples were determined.
CTA measurements of full-thickness cartilage defects showed high to perfect absolute agreement and consistency when compared with direct measurements (overall interclass correlation coefficient, 0.933 to 0.983; p < 0.05). For both operators, image-guided chondrocyte harvesting from the lateral ridge was more accurate (p = 0.007 and 0.040) and faster (p = 0.056 and 0.014) in comparison with harvesting from the medial ridge. In the clinical study, no significant difference was observed for the growth index of samples between the needle-harvest and conventional methods (p = 0.897).
CTA can be used for precise measurement of full-thickness cartilage defects. Image-guided chondrocyte harvesting is a viable alternative to traditional arthroscopic biopsy for ACI.
We recognize the current pivotal role of arthroscopic biopsy, as a part of ACI, for chondrocyte harvesting as well as for delineating the nature of the lesion. However, on the basis of our results, image-guided chondrocyte retrieval may obviate the need for arthroscopic biopsy in some patients in the future.
自体软骨细胞移植（ACI）是修复全层软骨缺损的一种有前景的方法，需要连续进行两次关节镜手术来采集和植入软骨细胞。在本研究中，我们评估了影像引导下软骨细胞采集作为关节镜活检替代方法的可行性和有效性。
我们在10具人类尸体膝关节上诱导产生全层软骨缺损。在关节腔内注射欧乃派克350后进行计算机断层扫描关节造影（CTA），以测量诱导产生的软骨缺损直径。随后，两名独立操作人员在每个膝关节上进行CTA引导下的软骨细胞采集（从内侧和外侧滑车嵴）。记录软骨细胞采集时间、准确性（CTA上预定义靶点与针的最终插入点之间的距离）以及针的重新调整次数。在机构审查委员会批准的临床研究中，获得了知情同意，并对10名适合进行ACI的受试者同时使用传统关节镜活检方法和通过关节镜入路部位用针进行软骨细胞采集。对样本进行盲法处理和培养，并确定样本的数量和质量。
与直接测量相比，CTA对全层软骨缺损的测量显示出高度至完美的绝对一致性和相关性（总体组内相关系数，0.933至0.983；p<0.05）。对于两名操作人员而言，与从内侧嵴采集相比，影像引导下从外侧嵴采集软骨细胞更准确（p = 0.007和0.040）且更快（p = 0.056和0.014）。在临床研究中，针吸采集法和传统方法采集的样本生长指数无显著差异（p = 0.897）。
CTA可用于精确测量全层软骨缺损。影像引导下软骨细胞采集是ACI中传统关节镜活检的可行替代方法。
我们认识到关节镜活检作为ACI的一部分，在软骨细胞采集以及明确病变性质方面目前起着关键作用。然而，基于我们的结果，影像引导下软骨细胞获取未来可能使部分患者无需进行关节镜活检。
