Blanke Fabian, Warth Franziska, Oehler Nicola, Siegl Johanna, Prall Wolf Christian
Department of Knee-, Hip-, Shoulder-, and Elbow Surgery, FIFA Medical Centre of Excellence Schön Klinik München Harlaching München Germany.
Department of Orthopedic Surgery University Rostock Rostock Germany.
J Exp Orthop. 2024 Oct 16;11(4):e70051. doi: 10.1002/jeo2.70051. eCollection 2024 Oct.
The treatment of cartilage lesions remains a challenge. Matrix-associated autologous chondrocyte implantation has evolved to become the gold standard procedure. However, this two-step procedure has crucial disadvantages, and the one-step minced cartilage procedure has gained attention. This retrospective study aimed to evaluate the clinical and radiological outcome of an all-autologous minced cartilage technique in cartilage lesions at the knee joint.
In this retrospective cohort study, 71 patients (38.6 years ± 12.0, 39,4% female) with a magnetic resonance imaging (MRI) confirmed grade III-IV cartilage defect at the medial femur condyle ( = 20), lateral femur condyle ( = 2), lateral tibia plateau ( = 1), retropatellar ( = 28) and at the trochlea ( = 20) were included. All patients were treated with an all-autologous minced cartilage procedure (AutoCart™). Clinical knee function was evaluated by the Tegner score, visual analogue scale, the subjective and objective evaluation form of the International Knee Documentation Committee and the Knee Injury and Osteoarthritis Outcome Score (KOOS). MRI analyses were performed by magnetic resonance observation of cartilage repair tissue (MOCART) 2.0 knee score. Follow-up examination was 13.7 ± 4.2 (12-24) months postoperative.
All clinical scores significantly improved after surgical intervention ( < 0.0001), especially the subgroup sports and recreation of KOOS showed clear changes from baseline in the follow-up examination. In the postoperative MRI evaluation, 39 of 71 patients showed a complete fill of the cartilage defect without subchondral changes in 78% of the patients in the MOCART 2.0 score in the follow-up analysis. None of the patients showed adverse effects, which are linked to the minced cartilage procedure during the time of follow-up.
An all-autologous minced cartilage technique for chondral lesions at the knee joint seems to be an effective and safe treatment method with good clinical and radiological short-term results.
Level IV.
软骨损伤的治疗仍然是一项挑战。基质相关自体软骨细胞植入已发展成为金标准手术。然而，这种两步法存在关键缺点，而一步法碎软骨手术已受到关注。这项回顾性研究旨在评估全自体碎软骨技术治疗膝关节软骨损伤的临床和放射学结果。
在这项回顾性队列研究中，纳入了71例患者（年龄38.6岁±12.0岁，女性占39.4%），其磁共振成像（MRI）证实股骨内侧髁（n = 20）、股骨外侧髁（n = 2）、胫骨外侧平台（n = 1）、髌后（n = 28）和滑车（n = 20）存在III-IV级软骨缺损。所有患者均接受全自体碎软骨手术（AutoCart™）治疗。通过Tegner评分、视觉模拟量表、国际膝关节文献委员会的主观和客观评估表以及膝关节损伤和骨关节炎疗效评分（KOOS）对膝关节功能进行临床评估。通过磁共振观察软骨修复组织（MOCART）2.0膝关节评分进行MRI分析。术后随访时间为13.7±4.2（12 - 24）个月。
手术干预后所有临床评分均显著改善（P < 0.0001），尤其是KOOS的运动和娱乐亚组在随访检查中与基线相比有明显变化。在术后MRI评估中，71例患者中有39例在随访分析中MOCART 2.0评分显示软骨缺损完全填充，78%的患者无软骨下改变。在随访期间，没有患者出现与碎软骨手术相关的不良反应。
全自体碎软骨技术治疗膝关节软骨损伤似乎是一种有效且安全的治疗方法，具有良好的临床和放射学短期效果。
IV级。
