Sumida Yoshikazu, Nakamura Kaori, Feil Sven, Siebold Maja, Kirsch Joachim, Siebold Rainer
International Center for Orthopedics, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany.
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Knee Surg Sports Traumatol Arthrosc. 2022 May;30(5):1535-1542. doi: 10.1007/s00167-021-06584-x. Epub 2021 Apr 23.
To report second-look arthroscopic assessment after all-arthroscopic autologous chondrocyte implantation (ACI) for articular cartilage defects at the patella.
A second-look arthroscopy after all-arthroscopic ACI using chondrospheres (ACT3D) was performed in 30 patients with 30 full-thickness retropatellar cartilage defects. The mean time from ACI to second-look arthroscopy was 14.9 ± 16.3 (6-71) months. The quality of cartilage regeneration was evaluated by the International Cartilage-Repair Score (ICRS)-Cartilage Repair Assessment (CRA).
Eleven lesions (36.7%) were classified as CRA grade I (normal) and 19 lesions (63.3%) as grade II (nearly normal). Concerning the degree of defect repair, 25 lesions (83.3%) were repaired up to the height of the surrounding articular retropatellar cartilage. Five lesions (16.7%) showed 75% repair of defect depth. The border zone was completely integrated into the surrounding articular cartilage shoulder in 28 lesions (93.3%) and demarcated within 1 mm in 2 lesions (6.7%). Macroscopically and by probing, 12 lesions (40%) had intact smooth surface, 17 lesions (56.7%) had fibrillated surface and 1 lesion (3.3%) had small, scattered fissures. A negative correlation was found between the overall repair assessment score and the defect size (r = - 0.430, p = 0.046) and between integration into border zone and defect size (r = - 0.340, p = 0.045). A positive correlation was found between macroscopic appearance and age (r = + 0.384, p = 0.036).
All-arthroscopic ACI using chondrospheres (ACT3D) for full-thickness retropatellar articular cartilage defects proved to be reproducible and reliable. The advantage of the procedure is that it is minimal invasive. Arthroscopic second-look demonstrated a high grade of normal or nearly normal cartilage regeneration. Although statistically significant differences were not observed, larger defect size and younger age may compromise the result of overall repair.
III.
报告关节镜下自体软骨细胞植入术（ACI）治疗髌骨关节软骨缺损后的二次关节镜评估结果。
对30例患有30处全层髌后软骨缺损的患者进行了关节镜下使用软骨球（ACT3D）的全关节镜下ACI后的二次关节镜检查。从ACI到二次关节镜检查的平均时间为14.9±16.3（6 - 71）个月。通过国际软骨修复评分（ICRS）-软骨修复评估（CRA）对软骨再生质量进行评估。
11处损伤（36.7%）被分类为CRA I级（正常），19处损伤（63.3%）为II级（接近正常）。关于缺损修复程度，25处损伤（83.3%）修复至髌后周围关节软骨的高度。5处损伤（16.7%）显示缺损深度修复了75%。28处损伤（93.3%）的边缘区完全融入周围关节软骨，2处损伤（6.7%）的边缘区界限在1毫米以内。在宏观和探查方面，12处损伤（40%）表面完整光滑，17处损伤（56.7%）表面纤维化，1处损伤（3.3%）有小的散在裂隙。总体修复评估评分与缺损大小之间存在负相关（r = - 0.430，p = 0.046），边缘区融合与缺损大小之间也存在负相关（r = - 0.340，p = 0.045）。宏观外观与年龄之间存在正相关（r = + 0.384，p = 0.036）。
关节镜下使用软骨球（ACT3D）对全层髌后关节软骨缺损进行全关节镜下ACI被证明是可重复且可靠的。该手术的优点是微创。关节镜二次检查显示软骨再生达到高等级的正常或接近正常。尽管未观察到统计学上的显著差异，但较大的缺损大小和较年轻的年龄可能会影响总体修复结果。
III级。
