Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L
Department of Orthopedic Surgery, University of Göteborg, Sahlgrenska University Hospital, Sweden.
N Engl J Med. 1994 Oct 6;331(14):889-95. doi: 10.1056/NEJM199410063311401.
Full-thickness defects of articular cartilage in the knee have a poor capacity for repair. They may progress to osteoarthritis and require total knee replacement. We performed autologous chondrocyte transplantation in 23 people with deep cartilage defects in the knee.
The patients ranged in age from 14 to 48 years and had full-thickness cartilage defects that ranged in size from 1.6 to 6.5 cm2. Healthy chondrocytes obtained from an uninvolved area of the injured knee during arthroscopy were isolated and cultured in the laboratory for 14 to 21 days. The cultured chondrocytes were then injected into the area of the defect. The defect was covered with a sutured periosteal flap taken from the proximal medial tibia. Evaluation included clinical examination according to explicit criteria and arthroscopic examination with a biopsy of the transplantation site.
Patients were followed for 16 to 66 months (mean, 39). Initially, the transplants eliminated knee locking and reduced pain and swelling in all patients. After three months, arthroscopy showed that the transplants were level with the surrounding tissue and spongy when probed, with visible borders. A second arthroscopic examination showed that in many instances the transplants had the same macroscopic appearance as they had earlier but were firmer when probed and similar in appearance to the surrounding cartilage. Two years after transplantation, 14 of the 16 patients with femoral condylar transplants had good-to-excellent results. Two patients required a second operation because of severe central wear in the transplants, with locking and pain. A mean of 36 months after transplantation, the results were excellent or good in two of the seven patients with patellar transplants, fair in three, and poor in two; two patients required a second operation because of severe chondromalacia. Biopsies showed that 11 of the 15 femoral transplants and 1 of the 7 patellar transplants had the appearance of hyaline cartilage.
Cultured autologous chondrocytes can be used to repair deep cartilage defects in the femorotibial articular surface of the knee joint.
膝关节全层关节软骨缺损的修复能力较差。它们可能会发展为骨关节炎，需要进行全膝关节置换。我们对23例膝关节深层软骨缺损患者进行了自体软骨细胞移植。
患者年龄在14至48岁之间，全层软骨缺损面积为1.6至6.5平方厘米。在关节镜检查期间，从受伤膝关节未受累区域获取健康软骨细胞，在实验室中分离并培养14至21天。然后将培养的软骨细胞注入缺损区域。缺损处用取自胫骨近端内侧的带蒂骨膜瓣缝合覆盖。评估包括根据明确标准进行的临床检查以及对移植部位进行活检的关节镜检查。
患者随访16至66个月（平均39个月）。最初，移植治疗消除了所有患者的膝关节交锁症状，并减轻了疼痛和肿胀。三个月后，关节镜检查显示移植组织与周围组织平齐，触诊时有海绵感，边界清晰。第二次关节镜检查显示，在许多情况下，移植组织的宏观外观与早期相同，但触诊时更坚实，外观与周围软骨相似。移植两年后，16例股骨髁移植患者中有14例效果良好至极佳。两名患者因移植组织严重中央磨损出现交锁和疼痛而需要二次手术。移植后平均36个月时，7例髌骨移植患者中有2例效果极佳或良好，3例效果一般，2例效果较差；两名患者因严重软骨软化需要二次手术。活检显示，15例股骨移植中有11例以及7例髌骨移植中有1例呈现透明软骨外观。
培养的自体软骨细胞可用于修复膝关节股骨胫关节面的深层软骨缺损。
