Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
Knee. 2020 Oct;27(5):1418-1425. doi: 10.1016/j.knee.2020.07.087. Epub 2020 Aug 20.
The present study evaluated short-term outcomes of microfracture augmented with micronized allograft cartilage matrix (BioCartilage) and platelet-rich plasma (PRP) for symptomatic focal femoral condyle or trochlea cartilage defects.
Patients who underwent microfracture augmented with BioCartilage and PRP for isolated contained chondral defects were evaluated. Magnetic resonance imaging (MRI) was performed at one year postoperatively. Two-year postoperative outcomes included patient-reported outcome measures (PROMs) and rates of return-to-work and return-to-sport.
Mean age of the 10 patients who completed the study was 39.7 years (range, 19-66 years), and five (50%) were female. Mean post-debridement defect size of the five femoral condyle and five trochlea defects was 2.4 cm (range, 0.7-5.0 cm). One-year postoperative MRI analysis demonstrated that two chondral lesions were <50% filled, four sites were >50% filled, two sites were completely filled, and two sites had hypertrophied. Patients experienced improvements in three PROMs at six months, one year, and two years postoperatively (p < 0.01). Postoperative Marx Activity scores revealed no decrease in activity level compared to baseline preoperatively. Nine patients (90%) returned to their pre-injury level of work by one year postoperatively and remained at that level through two years postoperatively.
Our findings suggest that small, contained focal chondral injuries in the femoral condyle and trochlea treated with a marrow stimulation procedure augmented with BioCartilage and PRP are associated with significant improvements in patient-reported outcomes at two years postoperatively. Further studies are needed to evaluate the long-term durability and imaging characteristics of this intervention. Level of evidence Therapeutic Level IV.
本研究评估了微骨折联合微化同种异体软骨基质(BioCartilage)和富血小板血浆(PRP)治疗症状性股骨髁或滑车关节软骨缺损的短期疗效。
评估了接受微骨折联合 BioCartilage 和 PRP 治疗孤立性、局限性软骨缺损的患者。术后一年进行磁共振成像(MRI)检查。术后两年的结果包括患者报告的结局测量(PROMs)和重返工作和运动的比例。
10 例完成研究的患者平均年龄为 39.7 岁(范围,19-66 岁),女性 5 例(50%)。5 例股骨髁和 5 例滑车软骨缺损的平均去骺后缺损大小为 2.4cm(范围,0.7-5.0cm)。术后一年的 MRI 分析显示,2 个软骨病变<50%填充,4 个部位>50%填充,2 个部位完全填充,2 个部位出现肥大。患者在术后 6 个月、1 年和 2 年时的 3 项 PROMs 均有改善(p<0.01)。术后 Marx 活动评分显示与术前基线相比,活动水平没有下降。9 例(90%)患者在术后 1 年恢复到受伤前的工作水平,并在术后 2 年保持在该水平。
我们的发现表明,股骨髁和滑车的小而局限的局灶性软骨损伤,采用骨髓刺激术联合 BioCartilage 和 PRP 治疗,与术后两年患者报告的结局显著改善相关。需要进一步研究来评估这种干预措施的长期耐久性和影像学特征。
治疗 IV 级。