■一些研究记录了基于软骨细胞的手术治疗髌股软骨损伤的长期结果,但是在基质辅助自体软骨细胞移植(MACT)治疗髌骨和滑车病变后缺乏具体结果.
■在长期随访中记录MACT治疗髌骨和滑车软骨缺损的临床结果。
■队列研究;证据水平,3.
■共有44例患者接受MACT术后髌股病变前瞻性评估。有24例受髌骨病变影响的患者,16由滑车损伤,4伴有髌骨和滑车缺损。使用国际膝关节文献委员会(IKDC)主观表格分析临床结果,EuroQol视觉模拟量表,术前和随访时间点5、10和至少15年的运动活动水平的Tegner评分(平均最终随访,17.6±1.6年)。进行Kaplan-Meier生存分析以检查生存至失败。失败被定义为由于与原发性缺陷相关的症状持续存在而需要进行第二次手术。
■记录了从基线到最后一次随访的总体显着改善。滑车组IKDC主观评分从基线时的41.0±13.3提高到5年时的83.9±21.6(P<.005),保持稳定直至最终随访(81.3±20.5)。髌骨组,IKDC主观评分从基线时的36.1±14.4提高到5年时的72.3±17.5(P<.005),保持稳定直至最终随访(62.0±20.3)。与5岁时髌骨病变患者相比,滑车病变患者的IKDC主观评分更高(P=0.029),10(P=.023),随访时间≥15年(P=.006)。Tegner评分也有类似的趋势,而髌骨和滑车病变之间的EuroQol视觉模拟量表评分没有差异。随访期间有4次失败(9.1%)。Kaplan-Meier生存分析显示滑车和髌骨病变之间没有统计学上的显着差异。
■这种基于透明质酸的MACT技术在长期随访中对受髌股软骨损伤影响的患者提供了积极和持久的临床结果,故障率低。然而,滑车和髌骨病变在临床表现和运动活动水平方面表现出显著差异,滑车病变患者的结果明显较高,但髌骨病变患者的预后较差。
UNASSIGNED: A few studies have documented the long-term results of chondrocyte-based procedures for the treatment of patellofemoral cartilage lesions, but specific results are lacking after matrix-assisted autologous chondrocyte transplantation (MACT) for patellar and trochlear lesions.
UNASSIGNED: To document the clinical results of MACT for the treatment of patellar and trochlear chondral defects at long-term follow-up.
UNASSIGNED: Cohort study; Level of evidence, 3.
UNASSIGNED: A total of 44 patients were prospectively evaluated after MACT for patellofemoral lesions. There were 24 patients affected by patellar lesions, 16 by trochlear lesions, and 4 with both patellar and trochlear defects. Clinical outcomes were analyzed using the International Knee Documentation Committee (IKDC) subjective form, EuroQol visual analog scale, and Tegner score for sport activity level before surgery and at follow-up time points of 5, 10, and a minimum of 15 years (mean final follow-up, 17.6 ± 1.6 years). A Kaplan-Meier survival analysis was performed to examine the survival to failure. Failure was defined as the need for a second surgery because of the persistence of symptoms related to the primary defect.
UNASSIGNED: An overall significant improvement was documented from baseline to the last follow-up. The IKDC subjective score improved in the trochlear group from 41.0 ± 13.3 at baseline to 83.9 ± 21.6 at 5 years (P < .005), remaining stable up to the final follow-up (81.3 ± 20.5). In the patellar group, the IKDC subjective score improved from 36.1 ± 14.4 at baseline to 72.3 ± 17.5 at 5 years (P < .005), remaining stable up to the final follow-up (62.0 ± 20.3). Patients with trochlear lesions presented higher IKDC subjective scores compared with those with patellar lesions at 5 (P = .029), 10 (P = .023), and ≥15 years (P = .006) of follow-up. Similar trends were documented for the Tegner score, while no differences were documented for the EuroQol visual analog scale score between patellar and trochlear lesions. There were 4 failures (9.1%) during the follow-up period. The Kaplan-Meier survival analysis did not show statistically significant differences between trochlear and patellar lesions.
UNASSIGNED: This hyaluronic acid-based MACT technique offered positive and durable clinical outcomes with a low failure rate at long-term follow-up in patients affected by patellofemoral cartilage lesions. However, trochlear and patellar lesions demonstrated a notable difference in terms of clinical findings and sport activity level, with significantly higher results for patients with trochlear lesions but less satisfactory outcomes for patients with patellar lesions.