Orthopädisch-Unfallchirurgisches Zentrum, Alb Fils Kliniken GmbH, Göppingen, Germany.
Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
Cartilage. 2022 Jul-Sep;13(3):19476035221102571. doi: 10.1177/19476035221102571.
To evaluate whether a sandwich technique procedure for large osteochondral lesions (OCL) of the medial femur condyle reduces clinical symptoms and improves activity level as well as to assess repair tissue integration on MRI over 2 years.
Twenty-one patients (median age: 29 years, 18-44 years) who received matrix-associated autologous chondrocyte transplantation (MACT) combined with cancellous bone grafting at the medial femur condyle in a 1-step procedure were prospectively included. Patients were evaluated before surgery (baseline) as well as 3, 6, 12, and 24 months postoperatively, including clinical evaluation, Lysholm score, Tegner Activity Rating Scale, and MRI with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS).
Seventeen patients were available for the 24-month (final) follow-up (4 dropouts). Lysholm significantly improved from 48 preoperatively stepwise to 95 at final follow-up ( < 0.05). Tegner improvement from 2.5 at baseline to 4.0 at final follow-up was not significant ( = 1.0). MOCART score improved significantly and stepwise from 65 at 3 months to 90 at 24 months ( < 0.05). Total WORMS improved from 14.5 at surgery to 7.0 after 24 months ( < 0.05). Body mass index and defect size at surgery correlated with total WORMS at final follow-up ( < 0.05) but did not correlate with clinical scores or defect filling.
MACT combined with cancellous bone grafting at the medial femoral condyle reduces symptoms continuously over 2 years. A 1-step procedure may reduce perioperative morbidity. However, despite improvements, patients' activity levels remain low, even 2 years after surgery.
评估内侧股骨髁大骨软骨病变（OCL）的三明治技术手术是否能减轻临床症状、提高活动水平，并评估 MRI 上 2 年的修复组织整合情况。
前瞻性纳入 21 例（中位年龄：29 岁，18-44 岁）接受内侧股骨髁基质相关自体软骨细胞移植（MACT）联合松质骨移植 1 步手术的患者。患者在术前（基线）及术后 3、6、12 和 24 个月进行评估，包括临床评估、Lysholm 评分、Tegner 活动评分量表和 MRI 检查，包括磁共振软骨修复组织观察评分（MOCART）和改良全器官磁共振成像评分（WORMS）。
17 例患者完成 24 个月（最终）随访（4 例脱落）。Lysholm 评分从术前的 48 分逐渐提高到最终随访的 95 分（<0.05）。Tegner 评分从基线的 2.5 分提高到最终随访的 4.0 分，但无统计学意义（=1.0）。MOCART 评分从术后 3 个月的 65 分逐渐提高到 24 个月的 90 分（<0.05）。WORMS 总评分从手术时的 14.5 分下降到 24 个月后的 7.0 分（<0.05）。BMI 和手术时的缺陷大小与最终随访时的 WORMS 总评分相关（<0.05），但与临床评分或缺陷填充无关。
内侧股骨髁 MACT 联合松质骨移植可在 2 年内持续减轻症状。1 步手术可能会降低围手术期发病率。然而，尽管有改善，但患者的活动水平仍然较低，即使在手术后 2 年。
