School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia.
HFRC Rehabilitation Clinic, Nedlands, Australia.
Am J Sports Med. 2021 Mar;49(3):579-587. doi: 10.1177/0363546520980109. Epub 2021 Jan 7.
Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging midterm clinical outcomes, although published studies presenting longer-term clinical and radiological outcomes, across varied tibiofemoral and patellofemoral graft locations, are scarce.
To present the clinical and radiological outcomes a minimum of 10 years after surgery in a consecutive series of patients who underwent MACI in the tibiofemoral or patellofemoral knee joint. Secondly, to investigate any association between outcomes and patient characteristics, graft parameters, and injury and surgery history.
Case series; Level of evidence, 4.
Overall, 87 patients (99 grafts: 57 medial femoral condyle, 24 lateral femoral condyle, 11 trochlea, 7 patella) were prospectively evaluated clinically and with magnetic resonance imaging (MRI) before surgery and at 2, 5, and minimum 10 years after MACI (mean, 13.1 years; range, 10.5-16 years). Patients were evaluated with a range of patient-reported outcome measures (PROMs), including the Knee injury and Osteoarthritis Outcome Score (KOOS) and patient satisfaction. The 6-minute walk test, active knee range of motion, and peak isokinetic knee extensor and flexor strength were assessed. Limb symmetry indices (LSIs) were calculated for strength measures. MRI was undertaken to evaluate the repair tissue, and an MRI composite score was calculated.
All PROMs significantly improved ( < .05) over the pre- to postoperative period. Apart from KOOS Sport ( = .018) and the LSI for peak isokinetic knee extensor strength ( = .005), which significantly improved, no significant change ( > .05) was observed from 2 years after surgery to final follow-up (range, 10.5-16 years) in all other PROMs, 6-minute walk distance, active knee range of motion, and the LSI for peak isokinetic knee flexor strength. At final follow-up, while the mean LSIs for peak isokinetic knee flexor and extensor strength were 96.9% and 95.7%, respectively, 74.7% of patients were satisfied with their ability to participate in sports, and 88.5% were satisfied overall. A nonsignificant decline was observed for tissue infill ( = .211) and the MRI composite score ( = .099) from 2 years to final review. At final MRI review, 9 grafts (9.1%) had failed. While no significant association ( > .05) was observed between clinical or MRI-based outcomes and patient demographics (age, body weight, body mass index), defect size, or the duration of preoperative symptoms, the number of previous surgical procedures was significantly and negatively associated with KOOS Symptoms ( = .015), KOOS Sport ( = .011), and the degree of tissue infill ( = .045).
MACI provided high levels of satisfaction and adequate graft survivorship as visualized on MRI at 10.5 to 16 years after surgery.
基质诱导的自体软骨细胞植入（MACI）已显示出令人鼓舞的中期临床结果，但发表的研究报告表明，在不同的胫骨股骨和髌股关节移植部位，更长时间的临床和影像学结果较为稀缺。
报告一组连续接受 MACI 治疗的患者在手术后至少 10 年的临床和影像学结果。其次，研究结果与患者特征、移植物参数以及损伤和手术史之间是否存在关联。
病例系列；证据水平，4 级。
共前瞻性评估了 87 例（99 个移植物：57 个股骨内侧髁、24 个股骨外侧髁、11 个滑车、7 个髌骨）患者的临床和磁共振成像（MRI）情况，包括术前、术后 2 年、5 年和至少 10 年（平均 13.1 年；范围，10.5-16 年）。患者使用一系列患者报告的结果测量（PROM）进行评估，包括膝关节损伤和骨关节炎结果评分（KOOS）和患者满意度。进行了 6 分钟步行测试、主动膝关节活动范围以及最大等速膝关节伸肌和屈肌力量的评估。计算了力量测量的肢体对称指数（LSI）。进行了 MRI 检查以评估修复组织，并计算了 MRI 综合评分。
所有 PROM 在术前至术后期间均显著改善（<0.05）。除了 KOOS 运动（=0.018）和最大等速膝关节伸肌力量的 LSI（=0.005）显著改善外，从术后 2 年至最终随访（范围，10.5-16 年），所有其他 PROM、6 分钟步行距离、主动膝关节活动范围以及最大等速膝关节屈肌力量的 LSI 均无显著变化（>0.05）。在最终随访时，最大等速膝关节伸肌和屈肌力量的平均 LSI 分别为 96.9%和 95.7%，74.7%的患者对其参与运动的能力感到满意，88.5%的患者总体满意。从 2 年到最终评估，组织填充（=0.211）和 MRI 综合评分（=0.099）的无显著下降。在最终的 MRI 复查时，有 9 个移植物（9.1%）失败。虽然临床或基于 MRI 的结果与患者人口统计学特征（年龄、体重、体重指数）、缺陷大小或术前症状持续时间之间无显著相关性（>0.05），但既往手术次数与 KOOS 症状（=0.015）、KOOS 运动（=0.011）和组织填充程度（=0.045）呈显著负相关。
MACI 在术后 10.5 至 16 年的 MRI 检查中提供了高水平的满意度和足够的移植物存活率。
