Monckeberg Juan Eduardo, Rafols Claudio, Gerhard Philipp, Del Canto Leticia, Rosales Julio, Verdugo Marco Antonio, Saez Cristobal, De la Fuente Carlos
Traumatologia, Clínica MEDS Santiago Chile.
Radiologia, Clínica MEDS Santiago Chile.
J Exp Orthop. 2024 Aug 30;11(3):e70009. doi: 10.1002/jeo2.70009. eCollection 2024 Jul.
To determine whether intra-articular injections of peripheral blood stem cells (PBSC) with hyaluronan (HA)-based scaffold improve articular cartilage regeneration in chondral injuries caused by mixed-femoroacetabular impingement syndrome (FAIS) over a period longer than 24 months post-hip arthroscopy.
In this prospective cohort study, patients with mixed-FAIS and chondral injury ≥ IIIB according to the International Cartilage Regeneration and Joint Preservation Society grade or III/IV of Konan/Haddad classification underwent intra-articular injection of PBSC with an HA-based scaffold and micro-drillings during hip arthroscopy. The degree of chondral repair was measured at baseline and 5 years using the International Cartilage Repair Society morphologic score system (MSS) as the primary outcome. Pain was measured at baseline and 5 years using the Visual Analogue Scale for Pain (VAS Pain), and hip functionality was measured at baseline (presurgery), 6 months, 1 year, and 5 years using the Hip Outcome Score (HOS). The largest diameter of injury, median follow-up, side effects, complications, and improvements were described. -test, ANOVA with multiple comparisons, and statistical power were estimated.
From initially 34 cases, 25 patients were enrolled. The median follow-up was 5.1 ± 0.3 years. One patient (4%) reported a few side effects with filgrastim administration. No infection, tumours, or synovitis was reported. The largest diameters in zones two, three, and four were 12.4 ± 3.1 mm ( = 8), 13.5 ± 2.8 mm ( = 14), and 11.4 ± 1.9 mm ( = 3), respectively. Ninety-two percent (23/25) of patients improved their outcomes. The MSS and HOS increased from 3.8 ± 1.1 to 9.6 ± 1.5 pts ( < 0.001) and from 65.5 ± 13.0 to 93.9 ± 2.4 pts ( < 0.001), respectively. The VAS-Pain decreased from 5.3 ± 0.7 to 1.3 ± 0.6 mm ( < 0.001). The obtained a power-size was 0.99.
The intervention suggests a favourable impact on articular cartilage regeneration and clinical outcomes for hip chondral lesions in mixed-FAIS injuries after a median follow-up of 5.1 ± 0.3 years.
Level IV.
确定在髋关节镜检查后超过24个月的时间里，关节内注射外周血干细胞（PBSC）与基于透明质酸（HA）的支架是否能改善混合性股骨髋臼撞击综合征（FAIS）所致软骨损伤的关节软骨再生。
在这项前瞻性队列研究中，根据国际软骨再生与关节保留学会分级为混合性FAIS且软骨损伤≥IIIB级或Konan/Haddad分类为III/IV级的患者，在髋关节镜检查期间接受了PBSC与基于HA的支架的关节内注射及微钻孔。使用国际软骨修复学会形态学评分系统（MSS）作为主要结局指标，在基线和5年时测量软骨修复程度。使用视觉模拟疼痛量表（VAS疼痛）在基线和5年时测量疼痛程度，并使用髋关节结局评分（HOS）在基线（术前）、6个月、1年和5年时测量髋关节功能。描述了损伤的最大直径、中位随访时间、副作用、并发症和改善情况。进行t检验、多重比较的方差分析，并估计统计效能。
最初的34例患者中，25例患者入组。中位随访时间为5.1±0.3年。1例患者（4%）报告在使用非格司亭时有一些副作用。未报告感染、肿瘤或滑膜炎。区域二、三、四的最大直径分别为12.4±3.1mm（n=8）、13.5±2.8mm（n=14）和11.4±1.9mm（n=3）。92%（23/25）的患者结局得到改善。MSS和HOS分别从3.8±1.1分提高到9.6±1.5分（P<0.001）和从65.5±13.0分提高到93.9±2.4分（P<0.001）。VAS疼痛从5.3±0.7mm降至1.3±0.6mm（P<0.001）。获得的效能大小为0.99。
在中位随访时间为5.1±0.3年后，该干预措施对混合性FAIS损伤的髋关节软骨损伤的关节软骨再生和临床结局显示出有利影响。
IV级。
