Hospital for Special Surgery, Sports Medicine Institute, New York, New York, USA.
Am J Sports Med. 2024 Mar;52(3):705-709. doi: 10.1177/03635465231220028. Epub 2024 Jan 20.
Cell-based cartilage repair procedures of the patellofemoral joint have less reliable outcomes than those of the tibiofemoral joint. No previous studies have evaluated the influence of patellar shape on cell-based cartilage repair outcomes. Patellar dysplasia may predispose patients to worse outcomes after cell-based cartilage repair.
PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate the relationship between Wiberg patellar type and outcomes after cell-based cartilage repair (autologous chondrocyte implantation or particulated juvenile allograft cartilage transplantation) for the treatment of patellar chondral lesions at a minimum 2-year follow-up. It was hypothesized that Wiberg classification of patellar shape would have no effect on patient-reported outcome measures (PROMs) or graft survival.
Cohort study; Level of evidence, 3.
Patients undergoing autologous chondrocyte implantation or particulated juvenile allograft cartilage transplantation for full-thickness patellar chondral defects between 2016 and 2020 were retrospectively reviewed after institutional review board approval. The change in PROMs, including International Knee Documentation Committee (IKDC), Kujala, and Veterans RAND 12-item Health Survey Mental and Physical scores, from pre- to postoperatively and the percentage of patients who achieved the minimal clinically important difference (MCID) for IKDC and Kujala scores were compared for the Wiberg type A versus Wiberg type B versus Wiberg type C groups. The log-rank test was used to evaluate for differences in survival between subgroups.
A total of 59 patients (63 knees) were included, with a mean age of 33.3 ± 8.6 years, median body mass index of 26.0 (IQR, 21.8-30.2), and median follow-up time of 3.5 years (IQR, 2.6-4.2 years). In total, 26 (41%) patellae were Wiberg type A, 29 (46%) were Wiberg type B, and 8 (13%) were Wiberg type C. There were no differences between Wiberg type A versus Wiberg type B versus Wiberg type C groups with respect to change in PROMs from pre- to postoperatively or the percentage of patients who achieved the MCID for IKDC or Kujala scores (P > .05 for all). There were no differences in survival between groups (P = .45).
Wiberg patellar type has no effect on patient-reported outcomes or graft survival at midterm follow-up. Patellar dysplasia should not be seen as a contraindication for cell-based cartilage repair procedures.
髌股关节的细胞基软骨修复程序的效果不如胫股关节的修复程序可靠。以前没有研究评估髌骨形状对细胞基软骨修复结果的影响。髌骨发育不良可能使患者在细胞基软骨修复后出现更差的结果。
本研究的目的是评估 Wiberg 髌骨类型与细胞基软骨修复（自体软骨细胞植入或颗粒状幼年同种异体软骨移植）治疗髌股软骨病变的关系，随访时间至少为 2 年。假设髌骨形状的 Wiberg 分类对患者报告的结果测量（PROM）或移植物存活率没有影响。
队列研究；证据水平，3 级。
在获得机构审查委员会批准后，回顾性分析了 2016 年至 2020 年间因全层髌股软骨缺损而接受自体软骨细胞植入或颗粒状幼年同种异体软骨移植的患者。比较 Wiberg 型 A 组、Wiberg 型 B 组和 Wiberg 型 C 组的 PROM 变化，包括国际膝关节文献委员会（IKDC）、Kujala 和退伍军人 RAND 12 项健康调查精神和身体评分，从术前到术后，以及达到 IKDC 和 Kujala 评分最小临床重要差异（MCID）的患者比例。使用对数秩检验评估亚组之间的生存差异。
共纳入 59 例患者（63 膝），平均年龄 33.3 ± 8.6 岁，中位体重指数为 26.0（IQR，21.8-30.2），中位随访时间为 3.5 年（IQR，2.6-4.2 年）。共有 26 例（41%）髌骨为 Wiberg 型 A，29 例（46%）为 Wiberg 型 B，8 例（13%）为 Wiberg 型 C。Wiberg 型 A 组与 Wiberg 型 B 组与 Wiberg 型 C 组之间，从术前到术后的 PROM 变化或达到 IKDC 或 Kujala 评分 MCID 的患者比例均无差异（所有 P >.05）。组间生存无差异（P =.45）。
在中期随访时，Wiberg 髌骨类型对患者报告的结果或移植物存活率没有影响。髌骨发育不良不应被视为细胞基软骨修复程序的禁忌症。
