School of Human Sciences (Exercise and Sport Science), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
HFRC Rehabilitation Clinic, 117 Stirling Highway, Nedlands, WA, 6009, Australia.
Knee Surg Sports Traumatol Arthrosc. 2021 Nov;29(11):3825-3833. doi: 10.1007/s00167-020-06422-6. Epub 2021 Jan 18.
To investigate the mid-term outcomes of an accelerated return to full weight bearing (WB) after matrix-induced autologous chondrocyte implantation (MACI).
This randomized study allocated 35 patients (37 knees) to a 6 week (n = 18) or 8 week (n = 19) return to full WB after MACI. Patients were evaluated pre-operatively and at 1, 2 and minimum 5 years (range 5.5-7 years), using the KOOS, SF-36, visual analogue pain scale, 6-min walk test and active knee range of motion (ROM). Peak isokinetic knee extensor and flexor strength was assessed, with limb symmetry indices (LSIs) calculated. Magnetic resonance imaging (MRI) was undertaken to evaluate the repair tissue, and an MRI composite score was calculated.
While no group differences (n.s.) were observed, significant improvement was observed for all patient-reported outcome measures (p < 0.05), 6-min walk distance (p = 0.040), active knee flexion (p = 0.002) and extension (p < 0.0001) ROM, and the LSI for peak knee extensor strength (p < 0.0001). At final review, 87.5% (6 weeks) and 82.4% (8 weeks) of patients were satisfied overall. A non-significant decline (n.s.) was observed for the MRI composite score from 1-year post-surgery to final review, with no significant MRI-based differences (n.s.) between groups. At final review, two grafts (6-week n = 1, 8-week n = 1) demonstrated MRI-based graft failure, while an additional patient had progressed toward knee arthroplasty (8.1% failure rate at minimum 5 years).
The 6-week return to full WB after MACI provided comparable clinical and MRI-based outcomes beyond 5 years post-surgery, without jeopardizing the graft. This 6-week WB protocol is faster than those previously proposed and studied.
II.
研究基质诱导自体软骨细胞移植（MACI）后加速恢复完全负重（WB）的中期结果。
本随机研究将 35 名患者（37 膝）分为 6 周（n=18）或 8 周（n=19）返回 MACI 后完全 WB。患者在术前和 1、2 及至少 5 年（范围 5.5-7 年）时进行评估，使用 KOOS、SF-36、视觉模拟疼痛量表、6 分钟步行测试和主动膝关节活动度（ROM）进行评估。评估了峰值等速膝关节伸肌和屈肌力量，并计算了肢体对称性指数（LSI）。进行了磁共振成像（MRI）检查以评估修复组织，并计算了 MRI 综合评分。
虽然组间无差异（无统计学意义），但所有患者报告的结果测量指标（p<0.05）、6 分钟步行距离（p=0.040）、主动膝关节屈曲（p=0.002）和伸展（p<0.0001）ROM 以及峰值膝关节伸肌力量的 LSI 均有显著改善（p<0.0001）。在最终随访时，6 周（87.5%）和 8 周（82.4%）的患者总体满意度较高。从术后 1 年到最终随访，MRI 综合评分有一个非显著的下降（无统计学意义），两组间无显著的 MRI 差异（无统计学意义）。在最终随访时，2 个移植物（6 周 n=1，8 周 n=1）显示 MRI 上的移植物失败，而另外 1 名患者进展为膝关节置换（5 年以上的失败率为 8.1%）。
MACI 后 6 周恢复完全 WB 提供了超过 5 年的手术的可比临床和 MRI 结果，而不会危及移植物。这种 6 周的 WB 方案比以前提出和研究的方案更快。
II。
