Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland.
Skeletal Radiol. 2024 Jul;53(7):1319-1332. doi: 10.1007/s00256-024-04582-x. Epub 2024 Jan 19.
To qualitatively and quantitatively evaluate the 2.5-year MRI outcome after Matrix-associated autologous chondrocyte implantation (MACI) at the patella, reconstruction of the medial patellofemoral ligament (MPFL), and combined procedures.
In 66 consecutive patients (age 22.8 ± 6.4years) with MACI at the patella (n = 16), MPFL reconstruction (MPFL; n = 31), or combined procedures (n = 19) 3T MRI was performed 2.5 years after surgery. For morphological MRI evaluation WORMS and MOCART scores were obtained. In addition quantitative cartilage T2 and T1rho relaxation times were acquired. Several clinical scores were obtained. Statistical analyses included descriptive statistics, Mann-Whitney-U-tests and Pearson correlations.
WORMS scores at follow-up (FU) were significantly worse after combined procedures (8.7 ± 4.9) than after isolated MACI (4.3 ± 3.6, P = 0.005) and after isolated MPFL reconstruction (5.3 ± 5.7, P = 0.004). Bone marrow edema at the patella in the combined group was the only (non-significantly) worsening WORMS parameter from pre- to postoperatively. MOCART scores were significantly worse in the combined group than in the isolated MACI group (57 ± 3 vs 88 ± 9, P < 0.001). Perfect defect filling was achieved in 26% and 69% of cases in the combined and MACI group, respectively (P = 0.031). Global and patellar T2 values were higher in the combined group (Global T2: 34.0 ± 2.8ms) and MACI group (35.5 ± 3.1ms) as compared to the MPFL group (31.1 ± 3.2ms, P < 0.05). T2 values correlated significantly with clinical scores (P < 0.005). Clinical Cincinnati scores were significantly worse in the combined group (P < 0.05).
After combined surgery with patellar MACI and MPFL reconstruction inferior MRI outcomes were observed than after isolated procedures. Therefore, patients with need for combined surgery may be at particular risk for osteoarthritis.
定性和定量评估膝关节前交叉韧带（MACI）、内侧髌股韧带（MPFL）重建和联合手术 2.5 年后的 MRI 结果。
对 66 例连续患者（年龄 22.8±6.4 岁）进行 3T MRI 检查，其中 16 例行膝关节前交叉韧带 MACI，31 例行 MPFL 重建，19 例行联合手术。对形态学 MRI 评估，采用 WORMS 和 MOCART 评分进行评估。此外，还获得了定量软骨 T2 和 T1rho 弛豫时间。获得了多项临床评分。统计分析包括描述性统计、Mann-Whitney-U 检验和 Pearson 相关性。
随访时（FU）联合手术组的 WORMS 评分（8.7±4.9）明显差于单纯 MACI 组（4.3±3.6，P=0.005）和单纯 MPFL 重建组（5.3±5.7，P=0.004）。联合组的髌骨关节骨髓水肿是唯一（非显著）WORMS 评分术后较术前恶化的参数。联合组的 MOCART 评分明显低于单纯 MACI 组（57±3 对 88±9，P<0.001）。联合组和 MACI 组分别有 26%和 69%的病例完全填充缺损（P=0.031）。与 MPFL 组相比，联合组（Global T2：34.0±2.8ms）和 MACI 组（35.5±3.1ms）的全局和髌骨关节 T2 值更高（P<0.05）。T2 值与临床评分显著相关（P<0.005）。联合组的 Cincinnati 临床评分明显较差（P<0.05）。
膝关节前交叉韧带和内侧髌股韧带重建联合手术后，MRI 结果较差，与单纯手术相比。因此，需要联合手术的患者可能特别容易发生骨关节炎。
