Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan.
Arthroscopy. 2022 Feb;38(2):441-449. doi: 10.1016/j.arthro.2021.05.026. Epub 2021 May 28.
To characterize bone marrow aspirate-derived fibrin clot (BMA clot) and evaluate the clinical result of meniscal repair with a BMA clot for isolated meniscal injury in the avascular zone.
Blood counts of total leukocytes, platelets, and concentrations of basic fibroblast growth factor (bFGF), transforming growth factor β (TGF-β), and stromal cell-derived factor 1 (SDF-1) were analyzed with BMA, peripheral blood (PB), BMA clot, and PB clot from 5 patients treated for meniscal repair. In addition, a retrospective analysis of 30 patients with isolated avascular meniscal injuries who underwent repair with a BMA clot was performed to assess rate failure. Avascular meniscal injury was identified as horizontal tear, radial tear, and flap tear. Clinical failure was defined as the presence of 1 or more of Barrett's criteria. Anatomic failure was defined as the existence of equivalent signal intensity to intra-articular fluid along the repair area on follow-up magnetic resonance imaging (MRI). Patients' demographic and clinical data were compared between the overall failure group and the success group.
The bFGF, TGF-β, and SDF-1 levels of BMA clots were more highly concentrated compared with PB clots. The Lysholm scores and meniscal status evaluated by MRI were significantly improved from preoperatively to postoperatively (both P < .001). The Kellgren-Lawrence grading of knee radiographs did not significantly differ pre- and postoperatively (P = .140). Rates of clinical failure, anatomic failure, and retear were 10%, 6.7%, and 3.3%, respectively. The demographic characteristics and surgical and postoperative status did not significantly differ between the overall failure group and the success group.
BMA clots had increased levels of cytokines compared to PB clots. The retrospective analysis revealed that the rates of clinical failure and anatomic failure after meniscal repair with a BMA clot for isolated avascular meniscal injury were 10% and 6.7%, respectively.
Level IV, case series.
对骨髓抽吸物衍生的纤维蛋白凝块（BMA 凝块）进行特征描述，并评估在无血管区孤立性半月板损伤中使用 BMA 凝块进行半月板修复的临床效果。
对 5 例接受半月板修复治疗的患者的骨髓抽吸物（BMA）、外周血（PB）、BMA 凝块和 PB 凝块的总白细胞、血小板计数以及碱性成纤维细胞生长因子（bFGF）、转化生长因子β（TGF-β）和基质细胞衍生因子 1（SDF-1）浓度进行分析。此外，对 30 例接受 BMA 凝块修复的孤立性无血管半月板损伤患者进行回顾性分析，以评估失败率。无血管半月板损伤被定义为水平撕裂、放射状撕裂和瓣状撕裂。临床失败定义为存在 1 项或多项 Barrett 标准。解剖学失败定义为在随访磁共振成像（MRI）上沿修复区域存在与关节内液体等效的信号强度。对整体失败组和成功组患者的人口统计学和临床数据进行比较。
BMA 凝块的 bFGF、TGF-β 和 SDF-1 水平明显高于 PB 凝块。Lysholm 评分和 MRI 评估的半月板状态在术前到术后均有显著改善（均 P<.001）。膝关节 X 线片的 Kellgren-Lawrence 分级在术前和术后差异无统计学意义（P=0.140）。临床失败、解剖学失败和再撕裂的发生率分别为 10%、6.7%和 3.3%。整体失败组和成功组的人口统计学特征、手术和术后情况差异无统计学意义。
与 PB 凝块相比，BMA 凝块具有更高水平的细胞因子。回顾性分析显示，在无血管区孤立性半月板损伤中使用 BMA 凝块进行半月板修复后，临床失败和解剖学失败的发生率分别为 10%和 6.7%。
IV 级，病例系列。
