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Abstract：
BACKGROUND: Treatment of osteochondral defects (OCDs) of the knee joint remains challenging. The purpose of this study was to evaluate the clinical and radiological results of osteochondral regeneration following intra-articular injections of autologous peripheral blood stem cells (PBSC) plus hyaluronic acid (HA) after arthroscopic subchondral drilling into OCDs of the knee joint.
METHODS: Five patients with OCDs of the knee joint are presented. The etiology includes osteochondritis dissecans, traumatic knee injuries, previously failed cartilage repair procedures involving microfractures and OATS (osteochondral allograft transfer systems). PBSC were harvested 1 week after surgery. Patients received intra-articular injections at week 1, 2, 3, 4, and 5 after surgery. Then at 6 months after surgery, intra-articular injections were administered at a weekly interval for 3 consecutive weeks. These 3 weekly injections were repeated at 12, 18 and 24 months after surgery. Each patient received a total of 17 injections. Subjective International Knee Documentation Committee (IKDC) scores and MRI scans were obtained preoperatively and postoperatively at serial visits. At follow-ups of >5 years, the mean preoperative and postoperative IKDC scores were 47.2 and 80.7 respectively (p = 0.005). IKDC scores for all patients exceeded the minimal clinically important difference values of 8.3, indicating clinical significance. Serial MRI scans charted the repair and regeneration of the OCDs with evidence of bone growth filling-in the base of the defects, followed by reformation of the subchondral bone plate and regeneration of the overlying articular cartilage.
CONCLUSIONS: These case studies showed that this treatment is able to repair and regenerate both the osseous and articular cartilage components of knee OCDs.
METHODS: Five patients with OCDs of the knee joint are presented. The etiology includes osteochondritis dissecans, traumatic knee injuries, previously failed cartilage repair procedures involving microfractures and OATS (osteochondral allograft transfer systems). PBSC were harvested 1 week after surgery. Patients received intra-articular injections at week 1, 2, 3, 4, and 5 after surgery. Then at 6 months after surgery, intra-articular injections were administered at a weekly interval for 3 consecutive weeks. These 3 weekly injections were repeated at 12, 18 and 24 months after surgery. Each patient received a total of 17 injections. Subjective International Knee Documentation Committee (IKDC) scores and MRI scans were obtained preoperatively and postoperatively at serial visits. At follow-ups of >5 years, the mean preoperative and postoperative IKDC scores were 47.2 and 80.7 respectively (p = 0.005). IKDC scores for all patients exceeded the minimal clinically important difference values of 8.3, indicating clinical significance. Serial MRI scans charted the repair and regeneration of the OCDs with evidence of bone growth filling-in the base of the defects, followed by reformation of the subchondral bone plate and regeneration of the overlying articular cartilage.
CONCLUSIONS: These case studies showed that this treatment is able to repair and regenerate both the osseous and articular cartilage components of knee OCDs.
摘要：
背景：膝关节骨软骨缺损（OCD）的治疗仍然具有挑战性。这项研究的目的是评估关节镜软骨下钻孔进入膝关节OCD后关节内注射自体外周血干细胞（PBSC）加透明质酸（HA）后骨软骨再生的临床和放射学结果。
方法：介绍了5例膝关节OCD患者。病因包括剥脱性骨软骨炎，创伤性膝盖受伤,以前失败的软骨修复程序涉及微骨折和OATS（同种异体骨软骨移植系统）。手术后1周收获PBSC。患者在手术后第1、2、3、4和5周接受关节内注射。手术后6个月,连续3周,每周一次进行关节内注射.在手术后12、18和24个月重复这3次每周注射。每位患者总共接受了17次注射。在连续访视的术前和术后获得主观国际膝关节文献委员会（IKDC）评分和MRI扫描。在超过5年的随访中，术前和术后IKDC平均评分分别为47.2和80.7(p=0.005).所有患者的IKDC评分均超过8.3的最小临床重要差异值，表明具有临床意义。系列MRI扫描显示OCD的修复和再生，并显示骨生长填充在缺损的底部，然后是软骨下骨板的重建和上覆的关节软骨的再生。
结论：这些病例研究表明，这种治疗能够修复和再生膝关节OCD的骨和关节软骨成分。
方法：介绍了5例膝关节OCD患者。病因包括剥脱性骨软骨炎，创伤性膝盖受伤,以前失败的软骨修复程序涉及微骨折和OATS（同种异体骨软骨移植系统）。手术后1周收获PBSC。患者在手术后第1、2、3、4和5周接受关节内注射。手术后6个月,连续3周,每周一次进行关节内注射.在手术后12、18和24个月重复这3次每周注射。每位患者总共接受了17次注射。在连续访视的术前和术后获得主观国际膝关节文献委员会（IKDC）评分和MRI扫描。在超过5年的随访中，术前和术后IKDC平均评分分别为47.2和80.7(p=0.005).所有患者的IKDC评分均超过8.3的最小临床重要差异值，表明具有临床意义。系列MRI扫描显示OCD的修复和再生，并显示骨生长填充在缺损的底部，然后是软骨下骨板的重建和上覆的关节软骨的再生。
结论：这些病例研究表明，这种治疗能够修复和再生膝关节OCD的骨和关节软骨成分。
