Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Am J Sports Med. 2024 Jul;52(9):2222-2229. doi: 10.1177/03635465241260238.
A few studies have documented the long-term results of chondrocyte-based procedures for the treatment of patellofemoral cartilage lesions, but specific results are lacking after matrix-assisted autologous chondrocyte transplantation (MACT) for patellar and trochlear lesions.
To document the clinical results of MACT for the treatment of patellar and trochlear chondral defects at long-term follow-up.
Cohort study; Level of evidence, 3.
A total of 44 patients were prospectively evaluated after MACT for patellofemoral lesions. There were 24 patients affected by patellar lesions, 16 by trochlear lesions, and 4 with both patellar and trochlear defects. Clinical outcomes were analyzed using the International Knee Documentation Committee (IKDC) subjective form, EuroQol visual analog scale, and Tegner score for sport activity level before surgery and at follow-up time points of 5, 10, and a minimum of 15 years (mean final follow-up, 17.6 ± 1.6 years). A Kaplan-Meier survival analysis was performed to examine the survival to failure. Failure was defined as the need for a second surgery because of the persistence of symptoms related to the primary defect.
An overall significant improvement was documented from baseline to the last follow-up. The IKDC subjective score improved in the trochlear group from 41.0 ± 13.3 at baseline to 83.9 ± 21.6 at 5 years ( < .005), remaining stable up to the final follow-up (81.3 ± 20.5). In the patellar group, the IKDC subjective score improved from 36.1 ± 14.4 at baseline to 72.3 ± 17.5 at 5 years ( < .005), remaining stable up to the final follow-up (62.0 ± 20.3). Patients with trochlear lesions presented higher IKDC subjective scores compared with those with patellar lesions at 5 ( = .029), 10 ( = .023), and ≥15 years ( = .006) of follow-up. Similar trends were documented for the Tegner score, while no differences were documented for the EuroQol visual analog scale score between patellar and trochlear lesions. There were 4 failures (9.1%) during the follow-up period. The Kaplan-Meier survival analysis did not show statistically significant differences between trochlear and patellar lesions.
This hyaluronic acid-based MACT technique offered positive and durable clinical outcomes with a low failure rate at long-term follow-up in patients affected by patellofemoral cartilage lesions. However, trochlear and patellar lesions demonstrated a notable difference in terms of clinical findings and sport activity level, with significantly higher results for patients with trochlear lesions but less satisfactory outcomes for patients with patellar lesions.
有一些研究记录了基于软骨细胞的方法治疗髌股软骨病变的长期结果，但在基质辅助自体软骨细胞移植（MACT）治疗髌股和滑车软骨病变后，具体结果尚缺乏报道。
在长期随访中记录 MACT 治疗髌股和滑车软骨缺损的临床结果。
队列研究；证据水平，3 级。
共对 44 例接受 MACT 治疗髌股病变的患者进行前瞻性评估。其中 24 例患者髌股病变，16 例滑车病变，4 例髌股和滑车均有缺损。使用国际膝关节文献委员会（IKDC）主观评分表、欧洲五维健康量表（EQ-5D）视觉模拟量表和 Tegner 运动水平评分，在术前和随访 5 年、10 年及至少 15 年（平均最终随访时间为 17.6±1.6 年）时分析临床结果。采用 Kaplan-Meier 生存分析来评估失败的情况。失败定义为因与原发缺陷相关的症状持续存在而需要再次手术。
从基线到最后随访，整体有显著的改善。在滑车组中，IKDC 主观评分从基线时的 41.0±13.3 提高到 5 年时的 83.9±21.6（<0.005），在最终随访时保持稳定（81.3±20.5）。在髌股组中，IKDC 主观评分从基线时的 36.1±14.4 提高到 5 年时的 72.3±17.5（<0.005），在最终随访时保持稳定（62.0±20.3）。滑车病变患者在 5 年（=0.029）、10 年（=0.023）和至少 15 年（=0.006）的随访中，IKDC 主观评分均高于髌股病变患者。Tegner 评分也呈现出相似的趋势，而髌股和滑车病变患者在 EQ-5D 视觉模拟量表评分上无差异。随访期间有 4 例（9.1%）失败。Kaplan-Meier 生存分析显示，滑车和髌股病变之间无统计学显著差异。
这项基于透明质酸的 MACT 技术在髌股软骨病变患者中提供了积极和持久的临床结果，且在长期随访中失败率较低。然而，滑车和髌股病变在临床发现和运动活动水平方面存在显著差异，滑车病变患者的结果明显更高，但髌股病变患者的结果则不太令人满意。
