背景:膝关节的软骨缺损由于其有限的自我修复能力而提出了重大挑战,常导致关节退化和功能障碍。目前的治疗方法,包括手术方法,如镶嵌成形术和再生疗法,如骨髓抽吸浓缩物(BMAC)增强,旨在解决这些缺陷并改善患者预后。
方法:这项研究进行了单中心,随机对照试验,以评估不同治疗方法和康复方案对软骨缺损的疗效。37名在股骨髁负重区域出现有症状的软骨或骨软骨缺损(>3cm2)的受试者被分为三组,并在有或没有BMAC扩增的情况下进行了马赛克成形术,接下来是6周或12周的康复计划。第1组(n=10)接受了马赛克成形术结合BMAC增强术,并进行了为期12周的两阶段康复方案。第2组(n=15)仅接受了马赛克成形术,并参加了相同的为期12周的两阶段康复方案。同时,第3组(n=12)接受了马赛克成形术,并接受了为期六周的较短的一期康复计划。临床评估使用视觉模拟量表(VAS)进行疼痛,膝关节运动范围(ROM)的测角,手动肌肉测试(MMT)的四头肌力量,以及西安大略省和麦克马斯特大学关节炎指数(WOMAC)在三个测试阶段进行功能评估。
结果:在中间阶段(F(2,34)=5.24,p<0.010)和最终阶段(F(2,34)=111,p<0.000),三组之间观察到WOMAC量表评分的显着差异。事后Tukey测试揭示了所有三组之间的差异。VAS量表的组间分析最初没有统计学意义(F(2,34)=0.18,p<0.982),但在中间(F(2,34)=11.40,p<0.000)和最终评估(F(2,34)=59.87,p<0.000)之后出现了显着差异,事后Tukey测试揭示了特定的群体变化,特别是在第1组和第2组和第3组之间,以及第3组和第2组之间。使用MMT评分对四头肌肌力进行的组间分析显示,最初(F(2,34)=0.376,p<0.689)或中间评估(F(2,34)=2.090,p<0.139)没有统计学上的显着差异。单因素方差分析显示初始膝关节ROM没有显著差异(F(2,34)=1.037,p<0.366),但在中间(F(2,34)=9.38,p<0.001)和最终评估(F(2,34)=11.60,p<0.000)后出现显著差异。事后Tukey测试显示,在中期和最终评估中,第1组和第2组,第1组和第3组以及第2和第3组之间存在显着差异。
结论:接受BMAC增强并完成12周康复方案的患者在疼痛缓解方面有明显更好的结果,膝关节功能,与未接受BMAC增强或完成较短康复期的人相比,ROM和ROM。我们的发现表明,将马赛克成形术与BMAC增强结合以及全面的康复计划可以为膝关节软骨缺损的患者带来出色的临床疗效。
BACKGROUND: Chondral defects in the knee present a significant challenge due to their limited self-healing capacity, often leading to joint degeneration and functional disability. Current treatments, including surgical approaches like
mosaicplasty and regenerative therapies such as bone marrow aspirate concentrate (BMAC) augmentation, aim to address these defects and improve patient outcomes.
METHODS: This study conducted a single-center, randomized controlled trial to evaluate the efficacy of different treatment approaches and rehabilitation protocols for chondral defects. Thirty-seven subjects presenting with symptomatic chondral or osteochondral defects (>3 cm2) in the weight-bearing region of the femoral condyle were partitioned into three groups, and underwent
mosaicplasty with or without BMAC augmentation, followed by either a 6-week or 12-week rehabilitation program. Group 1 (n = 10) received
mosaicplasty combined with BMAC augmentation and engaged in a twelve-week two-phase rehabilitation protocol. Group 2 (n = 15) underwent mosaicplasty alone and participated in the same twelve-week two-phase rehabilitation regimen. Meanwhile, Group 3 (n = 12) underwent
mosaicplasty and underwent a shorter six-week one-phase rehabilitation program. Clinical assessments were performed using the visual analog scale (VAS) for pain, goniometry for the knee\'s range of motion (ROM), manual muscle testing (MMT) for quadricep strength, and the Western Ontario and McMaster University Arthritis Index (WOMAC) for functional evaluation in three test phases.
RESULTS: Significant differences in WOMAC scale scores were observed between the three groups at the intermediate (F(2, 34) = 5.24, p < 0.010) and final (F(2, 34) = 111, p < 0.000) stages, with post hoc Tukey tests revealing variations shared among all three groups. The between-group analysis of the VAS scale demonstrated no statistically significant difference initially (F(2, 34) = 0.18, p < 0.982), but significant differences emerged following the intermediate (F(2, 34) = 11.40, p < 0.000) and final assessments (F(2, 34) = 59.87, p < 0.000), with post hoc Tukey tests revealing specific group variations, notably between Group 1 and both Group 2 and Group 3, and also between Group 3 and Group 2. The between-group analysis of quadricep muscle strength using MMT scores revealed no statistically significant differences initially (F(2, 34) = 0.376, p < 0.689) or following the intermediate assessment (F(2, 34) = 2.090, p < 0.139). The one-way ANOVA analysis showed no significant difference in the knee ROM initially (F(2, 34) = 1.037, p < 0.366), but significant differences emerged following intermediate (F(2, 34) = 9.38, p < 0.001) and final assessments (F(2, 34) = 11.60, p < 0.000). Post hoc Tukey tests revealed significant differences between Groups 1 and 2, Groups 1 and 3, and Groups 2 and 3 at intermediate and final assessments.
CONCLUSIONS: The patients who received BMAC augmentation and completed a 12-week rehabilitation protocol had significantly better outcomes in pain relief, knee function, and ROM when compared to those who did not receive BMAC augmentation or those who completed a shorter rehabilitation period. Our findings suggest that combining
mosaicplasty with BMAC augmentation and a comprehensive rehabilitation program can lead to superior clinical outcomes for patients with chondral defects in the knee.