Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Marchioninistr. 15, 81377, Munich, Germany.
Int Orthop. 2021 Jun;45(6):1483-1491. doi: 10.1007/s00264-020-04884-4. Epub 2020 Dec 6.
Femoral and patellar cartilage defects with a defect size > 2.5 cm are a potential indication for an autologous chondrocyte implantation (ACI). However, the influence of the localization and the absolute and relative defect size on the clinical outcome has not yet been determined. The purpose of this study is to analyze the influence of the localization and the absolute and relative defect size on the clinical outcome after third-generation autologous chondrocyte implantation.
A total of 50 patients with cartilage defects of the knee were treated with third-generation autologous chondrocyte implantation (Novocart® 3D). A match paired analysis was performed of 25 treated femoral and 25 treated patella defects with a follow-up of three years. MRI data was used to do the manual segmentation of the cartilage layer throughout the knee joint. The defect size was determined by taking the defect size measured in the MRI in relation to the whole cartilage area. The clinical outcome was measured by the IKDC score and VAS pre-operatively and after six, 12, 24, and 36 months post-operatively.
IKDC and VAS scores showed a significant improvement from the baseline in both groups. Femoral cartilage defects showed significantly superior clinical results in the analyzed scores compared to patellar defects. The femoral group improved IKDC from 33.9 (SD 18.1) pre-operatively to 71.5 (SD 17.4) after three years and the VAS from 6.9 (SD 2.9) pre-operatively to 2.4 (SD 2.5) after three years. In the patellar group, IKDC improved from 36.1 (SD 12.6) pre-operatively to 54.7 (SD 20.3) after three years and the VAS improved from 6.7 (SD 2.8) pre-operatively to 3.4 (SD 2.) after three years. Regarding the defect size, results showed that the same absolute defect size at med FC (4.8, range 2-15) and patella (4.6, range 2-12) has a significantly different share of the total cartilaginous size of the joint compartment (med FC: 6.7, range 1.2-13.9; pat: 18.9, range 4.0-47.0). However, there was no significant influence of the relative defect size on the clinical outcome in either patellar or femoral localization.
Third-generation autologous chondrocyte implantation in ACI-treated femoral cartilage defects leads to a superior clinical outcome in a follow-up of three years compared with patellar defects. No significant influence of the defect size was found in either femoral or patellar cartilage defects.
股骨和髌骨软骨缺损，缺损大小>2.5cm，是自体软骨细胞移植（ACI）的潜在适应证。然而，定位、绝对和相对缺损大小对临床结果的影响尚未确定。本研究旨在分析第三代自体软骨细胞移植后定位、绝对和相对缺损大小对临床结果的影响。
对 50 例膝关节软骨缺损患者行第三代自体软骨细胞移植（Novocart®3D）治疗。对随访 3 年的 25 例股骨和 25 例髌骨治疗缺陷进行配对分析。MRI 数据用于对整个膝关节软骨层进行手动分割。通过将 MRI 测量的缺损大小与整个软骨面积进行比较来确定缺损大小。临床结果通过 IKDC 评分和术前、术后 6、12、24 和 36 个月的 VAS 进行测量。
两组 IKDC 和 VAS 评分均较基线显著改善。与髌骨缺损相比，股骨软骨缺损的临床结果明显更好。股骨组 IKDC 从术前 33.9（SD 18.1）改善至术后 3 年的 71.5（SD 17.4），VAS 从术前 6.9（SD 2.9）改善至术后 3 年的 2.4（SD 2.5）。髌骨组 IKDC 从术前 36.1（SD 12.6）改善至术后 3 年的 54.7（SD 20.3），VAS 从术前 6.7（SD 2.8）改善至术后 3 年的 3.4（SD 2.0）。关于缺损大小，结果表明，在 FC 中相同的绝对缺损大小（4.8，范围 2-15）和髌骨（4.6，范围 2-12）具有显著不同的关节腔软骨总面积份额（FC：6.7，范围 1.2-13.9；髌骨：18.9，范围 4.0-47.0）。然而，在髌骨或股骨定位中，相对缺损大小对临床结果均无显著影响。
与髌骨缺损相比，ACI 治疗的股骨软骨缺损中第三代自体软骨细胞移植在 3 年的随访中导致更好的临床结果。在股骨或髌骨软骨缺损中，均未发现缺损大小有显著影响。
