Sports Medicine Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
Center for Cartilage Repair, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Am J Sports Med. 2019 Oct;47(12):2919-2926. doi: 10.1177/0363546519868213. Epub 2019 Aug 21.
Assays to quantitate the quality of autologous chondrocyte implants have recently become available. However, the correlation of the assay score with radiological and clinical outcomes has not been established.
PURPOSE/HYPOTHESIS: The purpose was to assess the influence of cell identity (chondrocyte/synoviocyte gene expression ratio) and viability on patient-reported outcome measures, graft survival, and repair tissue quality. It was hypothesized that greater cell product quality as assessed through an identity assay and cell viability is associated with superior outcomes after autologous chondrocyte implantation (ACI) for symptomatic cartilage defects.
Cohort study; Level of evidence, 3.
Seventy-nine patients with a minimum follow-up of 2 years were included in this study. Of these, 67 patients were available for imaging assessment utilizing the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. Patients were assigned to groups either below or above the cohort's mean based on their individual cell identity score and viability percentage.
Patients were predominantly female (57.7%) with a mean age of 30.0 ± 9.3 years. No differences were seen between Knee injury and Osteoarthritis Outcome Score, Lysholm, Tegner, or International Knee Documentation Committee Subjective Knee Evaluation Form within the viability and cell identity groups at a final follow-up of 3.8 ± 1.4 years after ACI ( > .05). In a subset of patients, the mean MOCART score was 68.3 ± 15.6 at an average magnetic resonance imaging follow-up of 17.7 ± 9.56 months. Low cell identity was significantly associated with the degree of defect filling ( = .025), integration of border zone ( = .01), effusion ( = .024), and ACI graft failure ( = .002). Patients with above-average cell identity scores had a significantly higher survival rate at 5-year follow-up compared with patients with below-average scores (95.8% vs 64.7%; = .013). Cell viability did not influence MOCART subscales or graft failure (all > .05). Cell viability and identity showed no significant correlation with each other ( = -0.045; = .694).
Cell identity was significantly correlated with structural repair quality and graft survival after second-generation ACI for symptomatic chondral lesions in the knee. While improved imaging outcome and higher graft survivorship were associated with a higher individual cell identity score indicating a higher chondrocyte/synoviocyte gene expression ratio in the final cell product, clinical outcome did not correlate with the identity score.
最近已经有了用于定量评估自体软骨细胞植入物质量的检测方法。然而，检测评分与影像学和临床结果的相关性尚未确定。
目的/假设：本研究旨在评估细胞特性（软骨细胞/滑膜细胞基因表达比率）和活力对患者报告的结果测量、移植物存活率和修复组织质量的影响。假设通过身份检测和细胞活力评估的细胞产品质量更高，与自体软骨细胞植入（ACI）治疗症状性软骨缺损后的优良结果相关。
队列研究；证据水平，3 级。
本研究纳入了 79 例至少随访 2 年的患者。其中，67 例患者可通过磁共振观察软骨修复组织（MOCART）评分系统进行影像学评估。根据患者的个体细胞身份评分和活力百分比，将患者分为低于或高于队列平均值的组。
患者主要为女性（57.7%），平均年龄为 30.0 ± 9.3 岁。在 ACI 后 3.8 ± 1.4 年的最终随访时，在活力和细胞身份组中，Knee injury and Osteoarthritis Outcome Score、Lysholm、Tegner 或 International Knee Documentation Committee Subjective Knee Evaluation Form 之间未见差异（>.05）。在部分患者中，平均 MOCART 评分为 68.3 ± 15.6，平均磁共振成像随访时间为 17.7 ± 9.56 个月。低细胞身份与缺陷填充程度显著相关（=.025），边界区整合（=.01），关节积液（=.024）和 ACI 移植物失败（=.002）显著相关。与细胞身份评分较低的患者相比，细胞身份评分较高的患者在 5 年随访时的存活率显著更高（95.8%比 64.7%；=.013）。细胞活力不影响 MOCART 亚量表或移植物失败（均>.05）。细胞活力和身份之间没有显著相关性（= -0.045；=.694）。
第二代 ACI 治疗膝关节症状性软骨病变后，细胞身份与结构修复质量和移植物存活率显著相关。虽然更好的影像学结果和更高的移植物存活率与最终细胞产物中更高的单个细胞身份评分相关，表明更高的软骨细胞/滑膜细胞基因表达比率有关，但临床结果与身份评分无关。
