Mitrousias Vasileios, Chalatsis Georgios, Mylonas Theodoros, Siouras Athanasios, Stergiadou Stella, Panteliadou Freideriki, Vlychou Marianna, Hantes Michael
Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences, University of Thessaly, 41110, Larissa, Greece.
Department of Computer Science and Biomedical Informatics, School of Science, University of Thessaly, 35131, Lamia, Greece.
Knee Surg Sports Traumatol Arthrosc. 2023 Dec;31(12):5698-5706. doi: 10.1007/s00167-023-07626-2. Epub 2023 Oct 30.
Osteochondral knee defects usually affect young, active patients and may alter knee biomechanics and progressively lead to joint degeneration. Various treatment options exist with autologous, impaction bone grafting in combination with autologous matrix-induced chondrogenesis (BG-AMIC) being a less-expensive, one-step, promising option. The purpose of this study is to evaluate the clinical and radiological mid-term outcomes of large osteochondral lesions treated with BG-AMIC, identify a possible correlation between the two and report postoperative complications and reoperation rate.
A retrospective analysis of 25 patients treated with the BG-AMIC technique for knee osteochondral lesions was performed. Patients were assessed using the following PROMs: the IKDC, the KOOS and the Lysholm score, the Tegner activity scale and a patient acceptable symptom state (PASS). The EQ-5D-5L score was used to assess health-related quality of life. Radiological assessment was performed using the MOCART 2.0 score on a 3 T MRI.
At a mean of 3.8 (± 0.8)-year follow-up, all functional scores increased significantly (p < 0.005) when compared to the preoperative baseline. IKDC increased from 44.5 (± 15.9) to 81.4 (± 14.7), KOOS from 41.5 (± 16.1) to 91.6 (± 11.6) and Lysholm from 54.4 (± 23) to 95.2 (± 5.5) (p < 0.005). The EQ-5D-5L score also revealed a significant improvement [59.9 (± 25) to 93.4 (± 10.2), p < 0.005]. Mean Tegner score reached pre-injury levels. The PASS was positive in 100% of patients. The minimum clinically important difference was reached in all PROMs except for the KOOS Sports subscale. There were no re-operations. Morphological evaluation of the repair tissue using the MOCART 2.0 score revealed a mean total score of 52.8 (± 30.5). A statistically significant, positive correlation was found between the MOCART 2.0 score and the IKDC score, the KOOS ADL subscale and the EQ-5D-5L (p < 0.05).
BG-AMIC is a safe and reliable option for treating deep, knee osteochondral lesions, providing a statistically significant and clinically important improvement in patient-reported outcomes. No complications were noticed, and no re-operations were performed after the procedure. A moderate positive correlation between the MOCART 2.0 score and the IKDC, KOOS ADL and EQ-5D-5L was noticed. However, this correlation is not necessarily clinically relevant, and excellent clinical results can be expected even in patients with low MOCART scores.
III.
膝关节骨软骨缺损通常影响年轻、活跃的患者，可能改变膝关节生物力学，并逐渐导致关节退变。存在多种治疗选择，自体嵌压植骨联合自体基质诱导软骨形成术（BG-AMIC）是一种费用较低、一步完成且有前景的选择。本研究的目的是评估采用BG-AMIC治疗大型骨软骨损伤的临床和影像学中期结果，确定两者之间可能的相关性，并报告术后并发症和再次手术率。
对25例采用BG-AMIC技术治疗膝关节骨软骨损伤的患者进行回顾性分析。使用以下患者报告结局测量指标（PROMs）对患者进行评估：国际膝关节文献委员会（IKDC）评分、膝关节损伤与骨关节炎疗效评分（KOOS）、Lysholm评分、Tegner活动量表以及患者可接受症状状态（PASS）。使用EQ-5D-5L评分评估健康相关生活质量。在3T磁共振成像（MRI）上采用膝关节软骨损伤修复组织MOCART 2.0评分进行影像学评估。
平均随访3.8（±0.8）年时，与术前基线相比，所有功能评分均显著提高（p<0.005）。IKDC评分从44.5（±15.9）提高到81.4（±14.7），KOOS评分从41.5（±16.1）提高到91.6（±11.6），Lysholm评分从54.4（±23）提高到95.2（±5.5）（p<0.005）。EQ-5D-5L评分也显示出显著改善[从59.9（±25）提高到93.4（±10.2），p<0.005]。平均Tegner评分达到伤前水平。100%的患者PASS为阳性。除KOOS运动亚量表外，所有PROMs均达到最小临床重要差异。无再次手术情况。使用MOCART 2.0评分对修复组织进行形态学评估，平均总分52.8（±30.5）。发现MOCART 2.0评分与IKDC评分、KOOS日常生活活动（ADL）亚量表评分和EQ-5D-5L评分之间存在统计学显著的正相关（p<0.05）。
BG-AMIC是治疗膝关节深层骨软骨损伤的一种安全可靠的选择，在患者报告结局方面有统计学显著且临床重要的改善。术后未发现并发症，也未进行再次手术。注意到MOCART 2.0评分与IKDC、KOOS ADL和EQ-5D-5L之间存在中度正相关。然而，这种相关性不一定具有临床意义，即使MOCART评分较低的患者也可预期获得良好的临床结果。
III级
