Figueroa David, Calvo Rodriguez Rafael, Donoso Rodrigo, Espinoza Jaime, Vaisman Alex, Yañez Claudio
Department of Orthopedic Surgery, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile.
Orthop J Sports Med. 2020 Jul 15;8(7):2325967120933138. doi: 10.1177/2325967120933138. eCollection 2020 Jul.
Patellar chondral defects represent up to 34.6% of defects found during routine arthroscopy. Surgical management has evolved during the past 20 years in an effort to develop techniques to replace hyaline cartilage. Currently, the only technique that achieves this is osteochondral autologous transfer (OAT). Although good and excellent results have often been reported at midterm and long-term follow-up for femoral lesions, little is known about isolated patellar defects.
To assess clinical and imaging results of patients treated with OAT for high-grade patellar defects.
Case series; Level of evidence, 4.
This was a retrospective study on all patients who received OAT for high-grade symptomatic patellar chondral defects between 2010 and 2018 at our institution. The study included patients younger than 40 years of age with anterior knee pain and a grade 4 International Cartilage Repair Society patellar chondral defect between 1 and 2.5 cm. Patients with surgery in other knee compartments, concomitant anterior cruciate ligament ruptures, infection, rheumatoid arthritis, and degenerative lesions were excluded. Six months postoperatively, all patients underwent magnetic resonance imaging (MRI) to allow assessment of graft integrity via the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score to evaluate morphologic features and integration. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kujala scores were used to assess functional outcomes at final follow-up.
A total of 26 patients who received a patellar OAT were included. Most patients were male (88.4%), and the mean ± SD age was 28.5 ± 9.7 years. Patellar chondral defects had a median size of 180 mm (range, 64-250 mm), and patients received a median of 1 autograft (range, 1-3). Functional outcomes assessed at a minimum of 1 year after surgery showed a mean Kujala score of 90.42 ± 6.7 and a mean WOMAC score of 95 ± 3.6. MRI revealed a median MOCART score of 75 points (range, 20-90 points).
To our knowledge, this is the largest series to date regarding isolated patellar OAT. At midterm follow-up, most patients reported good and excellent results regarding symptoms and activity levels. Most autografts showed good osseous integration and excellent filling of the chondral surface, as evidenced on MRI. OAT is a good alternative to treat high-grade patellar chondral defects, especially among young patients.
髌软骨损伤占常规关节镜检查中发现的损伤的34.6%。在过去20年中，手术治疗方法不断发展，旨在开发替代透明软骨的技术。目前，唯一能实现这一目标的技术是自体骨软骨移植（OAT）。尽管在股骨病变的中期和长期随访中经常报告良好和优异的结果，但对于孤立的髌骨缺损了解甚少。
评估接受OAT治疗的重度髌骨缺损患者的临床和影像学结果。
病例系列；证据等级，4级。
这是一项对2010年至2018年在我们机构接受OAT治疗重度有症状髌软骨损伤的所有患者的回顾性研究。该研究纳入了年龄小于40岁、有膝关节前疼痛且国际软骨修复协会髌骨软骨损伤为4级、大小在1至2.5厘米之间的患者。排除在其他膝关节腔进行过手术、伴有前交叉韧带断裂、感染、类风湿性关节炎和退行性病变的患者。术后6个月，所有患者均接受磁共振成像（MRI）检查，以通过MOCART（软骨修复组织磁共振观察）评分评估移植物的完整性，从而评估形态学特征和整合情况。使用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和库贾拉评分在最终随访时评估功能结果。
共纳入26例接受髌骨OAT的患者。大多数患者为男性（88.4%），平均年龄±标准差为28.5±9.7岁。髌软骨损伤的中位大小为180平方毫米（范围为64 - 250平方毫米），患者接受的自体移植物中位数量为1个（范围为1 - 3个）。术后至少1年评估的功能结果显示，库贾拉评分平均为90.42±6.7，WOMAC评分平均为95±3.6。MRI显示MOCART评分中位数为75分（范围为20 - 90分）。
据我们所知，这是迄今为止关于孤立髌骨OAT的最大系列研究。在中期随访中，大多数患者在症状和活动水平方面报告了良好和优异的结果。大多数自体移植物在MRI上显示出良好的骨整合和软骨表面的良好填充。OAT是治疗重度髌软骨损伤的一种良好替代方法，尤其是在年轻患者中。
