Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Stanford University, Stanford, California, USA.
Am J Sports Med. 2020 Apr;48(5):1134-1140. doi: 10.1177/0363546520908588. Epub 2020 Mar 17.
An unsalvageable osteochondritis dissecans (OCD) fragment has been defined as one that cannot be saved. Unsalvageable OCD lesions have been treated with various techniques, including fragment excision, microfracture, osteochondral autograft transfer, fresh osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI).
Patients who underwent ACI as treatment for unsalvageable OCD more than 10 years ago would maintain satisfactory patient-oriented outcome measures and have a low need for additional open surgery, especially arthroplasty.
Case series; Level of evidence, 4.
All Swedish and Norwegian patients (59 patients with 67 OCD lesions) who underwent ACI for OCD under the direction of the senior author between 1990 and 2005 were identified through manual chart review. Features of the patient, OCD lesion, and surgery were extracted from the medical record and intraoperative photographs. Patients were sent questionnaires to assess the Knee injury and Osteoarthritis Outcome Score, Tegner-Wallgren activity score, and Lysholm score. In addition, patients were asked whether they had to undergo further surgery, including knee replacement, of the knee that underwent ACI. They were asked whether they would have the surgery again if in the same situation.
A total of 55 patients (93%) with 61 OCD lesions (91%) responded. The median follow-up duration was 19 years (range, 10-26 years) and the median age at follow-up was 43 years (range, 28-69 years). Subsequent arthroscopy was performed in the majority of cases, although many of these were scheduled "second looks" as part of a study. With respect to other subsequent surgery, 12 knees (20%) underwent any additional open surgery, but only 2 knees (3%) underwent arthroplasty. Eight knees (13%) underwent revision ACI. Most patients reached their preinjury activity level (62%) and would undergo ACI again if in the same situation (85%). If failure is defined as revision of the graft or conversion to arthroplasty, then survivorship after ACI for OCD in the current study would be 87% at 10 years, 85% at 15 years, and 82% at 20 years.
ACI for OCD provides a durable treatment option. At a median follow-up of 19 years, there was a very low (~3%) conversion to total knee arthroplasty.
不可挽救的剥脱性骨软骨炎（OCD）病灶被定义为无法保留的病灶。不可挽救的 OCD 病灶已采用各种技术进行治疗，包括病灶切除、微骨折、骨软骨自体移植、新鲜骨软骨同种异体移植和自体软骨细胞移植（ACI）。
10 多年前接受 ACI 治疗不可挽救 OCD 的患者将保持满意的以患者为导向的结果测量，并且对进一步的开放性手术（尤其是关节置换术）的需求较低。
病例系列；证据水平，4 级。
通过手动图表审查，确定了所有在 1990 年至 2005 年间由资深作者指导下接受 ACI 治疗 OCD 的瑞典和挪威患者（59 例患者共 67 个 OCD 病灶）。从病历和术中照片中提取患者、OCD 病灶和手术的特征。患者被发送问卷以评估膝关节损伤和骨关节炎结果评分（Knee injury and Osteoarthritis Outcome Score，KOOS）、Tegner-Wallgren 活动评分和 Lysholm 评分。此外，患者还被问及他们是否需要接受进一步手术，包括接受 ACI 的膝关节的膝关节置换术。他们还被问到如果再次处于相同情况，是否会再次接受手术。
共有 55 名患者（93%）对 61 个 OCD 病灶（91%）做出了回应。中位随访时间为 19 年（范围，10-26 年），随访时的中位年龄为 43 岁（范围，28-69 岁）。尽管大多数情况下进行了后续关节镜检查，但其中许多检查是作为研究的一部分进行的“二次观察”。对于其他后续手术，12 个膝关节（20%）接受了任何进一步的开放性手术，但只有 2 个膝关节（3%）接受了关节置换术。8 个膝关节（13%）接受了翻修 ACI。大多数患者恢复到受伤前的活动水平（62%），并且如果再次处于相同情况，他们会再次接受 ACI（85%）。如果将失败定义为移植物翻修或转换为关节置换术，那么当前研究中 ACI 治疗 OCD 的 10 年、15 年和 20 年的存活率分别为 87%、85%和 82%。
ACI 治疗 OCD 提供了一种持久的治疗选择。在中位随访 19 年后，仅有约 3%的患者需要进行全膝关节置换术。
