Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University, Ismaninger Strasse 22, 81675, Munich, Germany.
Department of Orthopaedic Surgery, Paulinenhilfe, Diakonieklinikum, Stuttgart, Germany.
Knee Surg Sports Traumatol Arthrosc. 2022 Oct;30(10):3249-3257. doi: 10.1007/s00167-021-06764-9. Epub 2021 Oct 9.
Both acute ruptures of the anterior cruciate ligament (ACL) as well as chronic ACL insufficiency show a high association with focal cartilage defects of the knee. However, the results after combined ACL reconstruction and cartilage repair are not well investigated. The aim of the present study was to investigate the short-term outcomes after autologous chondrocyte implantation (ACI) in combination with ACL reconstruction and to compare the results with patients who underwent isolated ACI in ligament intact knees.
All patients who were registered in the German Cartilage Registry with ACI for focal cartilage defects in the knee joint in combination with ACL reconstruction and who completed the 24 month follow-up were included in the study group. A matched-pair procedure according to gender, defect location, defect size, and age was used to create a control group of patients with isolated ACI in ACL intact joints. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the numeric analog scale for pain (NAS) were used to assess the preoperative state as well as the clinical outcomes 12 and 24 months after surgery.
A total of 34 patients were included in both the study group (age mean 33.3 ± SD 8.8 years) and the control group (33.6 ± 8.4 years) with a median defect size of 466 (25%-75% IQR 375-600) mm and 425 (IQR 375-600) mm, respectively. In comparison with the preoperative state (median 67, IQR 52-75), the study group showed a significant increase of the total KOOS after 12 months (78, IQR 70-86; p = 0.014) and after 24 months (81, IQR 70-84; p = 0.001). The NAS for pain did not change significantly in the postoperative course. In comparison with the control group there was no significant difference for the total KOOS neither preoperative (control group median 67, IQR 52-73) nor at any postoperative time point (12 months: 82, IQR 67-93; 24 months: 81, IQR 71-91).
The clinical short-term outcomes after ACI at the knee joint in combination with ACL reconstruction are good and similar to the results after isolated ACI in ligament intact knees.
III.
急性前交叉韧带（ACL）撕裂以及慢性 ACL 不全与膝关节局灶性软骨缺损高度相关。然而，ACL 重建联合软骨修复的结果并未得到很好的研究。本研究的目的是探讨 ACL 重建联合自体软骨细胞移植（ACI）后的短期结果，并将结果与 ACL 完整膝关节中接受单纯 ACI 的患者进行比较。
本研究纳入了在德国软骨注册中心接受 ACL 重建联合膝关节局灶性软骨缺损 ACI 治疗，并完成 24 个月随访的患者。采用性别、病变部位、病变大小和年龄匹配的方法，创建了一组 ACL 完整关节中接受单纯 ACI 的患者作为对照组。使用膝关节损伤和骨关节炎评分（KOOS）和疼痛数字模拟评分（NAS）评估术前状态以及术后 12 个月和 24 个月的临床结果。
共有 34 例患者分别纳入研究组（年龄中位数 33.3 ± 8.8 岁）和对照组（33.6 ± 8.4 岁），中位数缺损大小分别为 466（25%-75% IQR 375-600）mm 和 425（IQR 375-600）mm。与术前状态（中位数 67，IQR 52-75）相比，研究组术后 12 个月（78，IQR 70-86；p=0.014）和 24 个月（81，IQR 70-84；p=0.001）时的 KOOS 总评分显著增加。术后疼痛的 NAS 无明显变化。与对照组相比，术前（对照组中位数 67，IQR 52-73）和任何术后时间点（12 个月：82，IQR 67-93；24 个月：81，IQR 71-91）的 KOOS 总评分均无显著差异。
ACL 重建联合膝关节 ACI 的短期临床结果良好，与 ACL 完整膝关节中接受单纯 ACI 的结果相似。
III 级。
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