Hanna Adeeb Jacob, Perez Andres R, Destine Henson, Campbell Michael P, Looney Austin, Farronato Dominic, Pezzulo Joshua, Tucker Bradford S, Freedman Kevin B
Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A.
Arthrosc Sports Med Rehabil. 2024 May 9;6(4):100951. doi: 10.1016/j.asmr.2024.100951. eCollection 2024 Aug.
To compare osteochondral defect size measurements and characteristics across magnetic resonance imaging (MRI) and arthroscopy and at the time of osteochondral allograft (OCA) transplantation or autologous chondrocyte implantation (ACI).
Patients who underwent ACI and OCA transplantation at a single institution between 2015 and 2019 were retrospectively identified. Patients were excluded if they had severe osteoarthritis, MRI scans were not available for review, surgical records did not include defect sizing necessary for analysis, or operative reports were not available. Osteochondral lesion characteristics including size were collected preoperatively by MRI and arthroscopy and at the time of definitive open surgical intervention. Subgroup analysis was performed comparing measurement techniques depending on the corrective surgical approach used, as well as depending on the mechanism of chondral injury, to determine whether these factors had any effect on the ability of arthroscopy or MRI to predict graft size.
Overall, 136 chondral lesions were addressed, with restoration procedures in 117 patients (mean age, 32.5 years). The average difference between the final graft size and the lesion area measured with index arthroscopy was 116 mm, whereas the average difference between the final graft size and the lesion size measured with preoperative MRI was 182 mm ( < .001). Depending on surgical technique, measurements with MRI were more similar to the final graft size when a patient underwent OCA transplantation versus ACI ( = .007). Depending on the mechanism of injury, MRI measurements of lesions were closer to the graft area when lesions resulted from trauma ( = .047).
Chondral lesion size as determined by preoperative MRI is less accurate than arthroscopic measurement. The mechanism of injury leading to chondral damage and degree of damage may influence the ability of MRI and arthroscopy to accurately measure chondral lesions and predict the final graft size used in surgical correction.
Level III, retrospective cohort study.
比较磁共振成像（MRI）与关节镜检查时以及骨软骨异体移植（OCA）或自体软骨细胞植入（ACI）时的骨软骨缺损大小测量及特征。
回顾性确定2015年至2019年间在单一机构接受ACI和OCA移植的患者。如果患者患有严重骨关节炎、无法获得MRI扫描以供审查、手术记录不包括分析所需的缺损大小或没有手术报告，则将其排除。术前通过MRI和关节镜检查以及在确定性开放手术干预时收集包括大小在内的骨软骨损伤特征。根据所采用的矫正手术方法以及软骨损伤机制进行亚组分析，以确定这些因素是否对关节镜检查或MRI预测移植大小的能力有任何影响。
总体而言，共处理了136处软骨损伤，117例患者（平均年龄32.5岁）接受了修复手术。最终移植大小与关节镜检查测量的损伤面积之间的平均差异为116平方毫米，而最终移植大小与术前MRI测量的损伤大小之间的平均差异为182平方毫米（P<0.001）。根据手术技术，与ACI相比，接受OCA移植的患者MRI测量值与最终移植大小更相似（P = 0.007）。根据损伤机制，当损伤由创伤引起时，MRI测量的损伤更接近移植面积（P = 0.047）。
术前MRI确定的软骨损伤大小不如关节镜测量准确。导致软骨损伤的损伤机制和损伤程度可能会影响MRI和关节镜检查准确测量软骨损伤并预测手术矫正中使用的最终移植大小的能力。
III级，回顾性队列研究。
