Reinhart Nolan M, Tate Jackson P, Imonugo Onyebuchi A, Heard Wendell M, Sherman William F
Tulane University School of Medicine, New Orleans, Louisiana, USA.
Orthop J Sports Med. 2025 Sep 15;13(9):23259671251355162. doi: 10.1177/23259671251355162. eCollection 2025 Sep.
Management of chondral injury can be difficult due to the avascularity of articular cartilage and the limited ability to proliferate and promote repair. Untreated lesions can lead to early development of arthritis and the need for joint replacement. For intermediate-sized lesions, osteochondral autograft transfer and autologous cell-based cartilage treatment have been accepted as the most effective treatment options.
To investigate the rates of complications within 2 years of initial surgery in patients who undergo primary autologous cell-based cartilage treatment and osteochondral autograft.
Cohort study; Level of evidence, 3.
A retrospective cohort study was performed on July 17, 2024, using a commercially available insurance claims database to investigate 2-year orthopaedic complication rates in 1298 patients after primary osteochondral autograft and autologous cell-based cartilage treatment for chondral injuries of the knee. Patient cohorts were propensity score matched with a caliper set to 0.2 at a ratio of 1 to 1 on the following variables: age, sex, diabetes, and tobacco use. Rates of surgical complications were compared using multivariable logistic regression, adjusted for age, sex, diabetes, obesity, and tobacco use. Odds ratios (ORs) with corresponding 95% CIs were calculated for each comparison.
A total of 1298 patients were included in this retrospective analysis. Patients who underwent autologous cell-based cartilage treatment were significantly more likely to need revision cartilage restoration surgery compared with those who underwent osteochondral autograft treatment (11.1% vs 7.4%; OR, 1.58 [95% CI, 1.08-2.34]). There was no significant difference in the rate of progression to osteoarthritis (11.4% vs 10.6%; OR, 1.15; [95% CI, 0.80-1.65]) or subsequent knee arthroplasty (0.5% vs 1.1%; OR, 0.54 [95% CI, 0.11-2.06]) within 2 years of initial procedure between the treatment cohorts.
This study highlights the increased risk of revision for patients who underwent autologous cell-based cartilage treatment compared with those who underwent osteochondral autograft treatment. However, no significant difference was identified in progression to osteoarthritis or subsequent knee arthroplasty within 2 years after the initial procedure. Further studies that evaluate long-term outcomes and the progression of symptoms are needed.
由于关节软骨无血管性以及增殖和促进修复的能力有限，软骨损伤的管理可能具有挑战性。未经治疗的损伤可导致关节炎的早期发展以及关节置换的需求。对于中等大小的损伤，骨软骨自体移植和基于自体细胞的软骨治疗已被认为是最有效的治疗选择。
调查接受初次基于自体细胞的软骨治疗和骨软骨自体移植的患者在初次手术后2年内的并发症发生率。
队列研究；证据等级，3级。
2024年7月17日进行了一项回顾性队列研究，使用可商购的保险理赔数据库调查1298例因膝关节软骨损伤接受初次骨软骨自体移植和基于自体细胞的软骨治疗后2年的骨科并发症发生率。患者队列在以下变量上按1:1的比例进行倾向评分匹配，卡尺设置为0.2：年龄、性别、糖尿病和吸烟情况。使用多变量逻辑回归比较手术并发症发生率，并对年龄、性别、糖尿病、肥胖和吸烟情况进行校正。每次比较计算相应95%可信区间的比值比（OR）。
本回顾性分析共纳入1298例患者。与接受骨软骨自体移植治疗的患者相比，接受基于自体细胞的软骨治疗的患者更有可能需要进行软骨修复翻修手术（11.1%对7.4%；OR，1.58[95%CI，1.08 - 2.34]）。在初次手术后2年内，治疗队列之间的骨关节炎进展率（11.4%对10.6%；OR，1.15；[95%CI，0.80 - 1.65]）或随后的膝关节置换率（0.5%对1.1%；OR，0.54[95%CI，0.11 - 2.06]）没有显著差异。
本研究强调了与接受骨软骨自体移植治疗的患者相比，接受基于自体细胞的软骨治疗的患者翻修风险增加。然而，在初次手术后2年内，骨关节炎进展或随后的膝关节置换方面未发现显著差异。需要进一步评估长期结果和症状进展的研究。
