Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
OFZ Weilheim, Weilheim, Germany.
Knee Surg Sports Traumatol Arthrosc. 2022 Oct;30(10):3334-3342. doi: 10.1007/s00167-022-06899-3. Epub 2022 Feb 26.
To investigate clinical and magnetic resonance (MR) imaging results of patients undergoing patella stabilization with either open flake refixation (oFR) or autologous chondrocyte implantation (ACI) and concomitant soft tissue patella stabilization after sustaining primary, acute patella dislocation with confirmed chondral and/or osteochondral flake fractures. It was hypothesized that refixation will lead to better results than ACI at mid-term follow-up.
A retrospective chart review was conducted to identify all patients undergoing oFR or ACI after sustaining (osteo-)chondral flake fractures and concomitant soft tissue patella stabilization following primary, acute patella dislocation between 01/2012 and 09/2018 at the author's institution. Patients were excluded if they were aged < 14 years or > 30 and had previous knee surgeries at the index knee. Clinical outcomes were assessed using the Tegner activity score, Kujala score, subjective IKDC score, and the KOOS score at a minimum follow-up of 24 months postoperatively. MR images were assessed using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 knee score. Thirty patients were included in the study, with 16 patients assorted to the oFR group and 14 patients to the ACI group (Follow-up 81%).
Demographic data did not show significant group differences (oFR: 6 females, 10 males; age 26.9 ± 5.6 years, FU: 57 months (27-97 months); ACI: 9 females, 5 males; age 25.5 ± 4.9 years, FU: 51 months (29-91 months); n.s.). Defect location was similar in both groups (oFR: 12 × patella/4 × lateral femoral condyle; ACI: 12/2; n.s.). Both groups showed excellent clinical outcomes, with no statistically significant difference between both the groups (oFR group vs. ACI group: Tegner: 5.1 ± 1.8 vs. 5.1 ± 1.4; Kujala: 86.1 ± 12.6 vs. 84.9 ± 9.1; IKDC: 83.8 ± 15.0 vs. 83.6 ± 11.3; KOOS: 83.3 ± 14.0 vs. 83.6 ± 12.0; n.s.). One patient in each group suffered a patella re-dislocation and needed revision surgery. The MOCART 2.0 score showed good results for the oFR group (68.2 ± 11.1) and the ACI group (61.1 ± 16.9) while no significant differences were noted between both the groups. The inter-rater reliability was excellent (0.847).
Open refixation of (osteo-)chondral fragments in patients after sustaining acute patella dislocation with (osteo)-chondral flake fractures led to good clinical and radiological results at a minimum follow of 24 months, showing that it is a good surgical option in the treatment algorithm. However, if open refixation is not possible, ACI may be an excellent fallback option in these younger patients with equally good clinical and radiological outcomes, but requiring a second minimally invasive surgery.
III.
研究在初次急性髌骨脱位伴软骨和/或骨软骨片骨折后行髌骨稳定化的患者中，采用切开髌骨再固定术（oFR）或自体软骨细胞移植（ACI）联合同期软组织髌骨稳定化治疗的临床和磁共振（MR）成像结果。假设在中期随访时，固定术的结果优于 ACI。
对 2012 年 1 月至 2018 年 9 月间作者机构中初次急性髌骨脱位伴（骨）软骨片骨折和同期软组织髌骨稳定化后行 oFR 或 ACI 的所有患者进行回顾性图表分析。如果患者年龄＜14 岁或＞30 岁，且在指数膝关节有既往膝关节手术史，则将其排除在外。使用 Tegner 活动评分、Kujala 评分、主观 IKDC 评分和 KOOS 评分评估临床结果，术后至少随访 24 个月。使用磁共振观察软骨修复组织（MOCART）2.0 膝关节评分评估 MR 图像。本研究纳入 30 例患者，其中 16 例患者归入 oFR 组，14 例患者归入 ACI 组（随访 81%）。
两组患者的人口统计学数据无显著差异（oFR 组：6 名女性，10 名男性；年龄 26.9±5.6 岁，随访时间 57 个月（27-97 个月）；ACI 组：9 名女性，5 名男性；年龄 25.5±4.9 岁，随访时间 51 个月（29-91 个月）；n.s.）。两组的缺损位置相似（oFR 组：12×髌骨/4×外侧股骨髁；ACI 组：12/2；n.s.）。两组均表现出良好的临床结果，两组之间无统计学差异（oFR 组与 ACI 组：Tegner：5.1±1.8 vs. 5.1±1.4；Kujala：86.1±12.6 vs. 84.9±9.1；IKDC：83.8±15.0 vs. 83.6±11.3；KOOS：83.3±14.0 vs. 83.6±12.0；n.s.）。每组中有 1 例患者发生髌骨再脱位，需要进行翻修手术。oFR 组（68.2±11.1）和 ACI 组（61.1±16.9）的 MOCART 2.0 评分均显示出良好的结果，且两组之间无显著差异。组内可靠性为极好（0.847）。
初次急性髌骨脱位伴（骨）软骨片骨折患者行切开髌骨再固定术可获得良好的临床和影像学结果，在至少 24 个月的随访中，这是一种很好的治疗方案。然而，如果无法行切开髌骨再固定术，ACI 可能是这些年轻患者的另一种极好的替代方案，同样具有良好的临床和影像学结果，但需要进行第二次微创手术。
III 级。
