Background:Long-term outcomes in larger cohorts after matrix-induced autologous chondrocyte implantation (MACI) are required. Furthermore, little is known about the longer-term clinical and radiological outcomes of MACI performed in the tibiofemoral versus patellofemoral knee joint.Purpose:To present the 10-year clinical and radiological outcomes in patients after MACI and compare outcomes in patients undergoing tibiofemoral versus patellofemoral MACI.Study Design:Case series; Level of evidence, 4.Methods:Between September 2002 and December 2012, 204 patients who underwent MACI were prospectively registered into a research program and assessed preoperatively and at 2, 5, and 10 years postoperatively. Of these patients, 168 were available for clinical review at 10 years, with 151 (of a total of 182) grafts also assessed via magnetic resonance imaging (MRI). Patients were evaluated using the Knee injury and Osteoarthritis Outcome Score, a visual analog scale for pain frequency and severity, satisfaction, and peak isokinetic knee extensor and flexor strength. Limb symmetry indices (LSIs) were calculated for strength measures. Grafts were scored on MRI scans via the MOCART (magnetic resonance observation of cartilage repair tissue) system, with a focus on tissue infill and an overall MRI graft composite score.Results:All patient-reported outcome measures improved ( P < .0001) up to 2 years after surgery. Apart from the significant increase ( P = .004) in the peak isokinetic knee extensor LSI, no other patient-reported outcome measure or clinical score had changed significantly from 2 to 10 years. At the final follow-up, 92% of patients were satisfied with MACI to provide knee pain relief, with 76% satisfied with their ability to participate in sports. From 2 to 10 years, no significant change was seen for any MRI-based MOCART variable nor the overall MRI composite score. Of the 151 grafts reviewed via MRI at 10 years, 14 (9.3%) had failed, defined by graft delamination or no graft tissue on MRI scan. Furthermore, of the 36 patients (of the prospectively recruited 204) who were not available for longer-term review, 7 had already proceeded to total knee arthroplasty, and 1 patient had undergone secondary MACI at the same medial femoral condylar site because of an earlier graft failure. Therefore, 22 patients (10.8%) essentially had graft failure over the period. At the final follow-up, patients who underwent MACI in the tibiofemoral (vs patellofemoral) joint reported significantly better Knee injury and Osteoarthritis Outcome Score subscale scores for Quality of Life ( P = .010) and Sport and Recreation ( P < .001), as well as a greater knee extensor strength LSI ( P = .002). Even though the tibiofemoral group demonstrated better 10-year MOCART scores for tissue infill ( P = .027), there were no other MRI-based differences ( P > .05).Conclusion:This study reports the long-term review of a prospective series of patients undergoing MACI, demonstrating good clinical scores, high levels of patient satisfaction, and acceptable graft survivorship at 10 years. Patients undergoing tibiofemoral (vs patellofemoral) MACI reported better long-term clinical outcomes, despite largely similar MRI-based outcomes.

中文翻译：

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基质诱导自体软骨细胞植入后 10 年前瞻性临床和放射学评估以及胫股骨和髌股骨移植结果的比较

背景：需要在基质诱导的自体软骨细胞植入（MACI）后在更大的队列中获得长期结果。此外，对于胫股膝关节与髌股膝关节进行 MACI 的长期临床和放射学结果知之甚少。 目的：展示 MACI 术后患者 10 年的临床和放射学结果，并比较接受胫股关节与髌股关节的患者的结果MACI.研究设计：案例系列；证据水平，4。方法：2002年9月至2012年12月期间，204名接受MACI的患者前瞻性地注册到一项研究计划中，并在术前以及术后2年、5年和10年进行评估。在这些患者中，168 名患者在 10 年后可进行临床审查，其中 151 名（总共 182 名）移植物还通过磁共振成像 (MRI) 进行了评估。使用膝关节损伤和骨关节炎结果评分（一种疼痛频率和严重程度、满意度以及峰值等速膝关节伸肌和屈肌力量的视觉模拟量表）对患者进行评估。计算肢体对称指数（LSI）以进行力量测量。通过 MOCART（软骨修复组织磁共振观察）系统对移植物进行 MRI 扫描评分，重点关注组织填充和整体 MRI 移植物综合评分。结果：所有患者报告的结果指标均有所改善 ( P < .0001)至手术后2年。除了峰值等速伸膝肌 LSI 显着增加 (P = .004) 外，2 至 10 年间，患者报告的其他结果指标或临床评分没有显着变化。在最后一次随访中，92% 的患者对 MACI 缓解膝盖疼痛的效果感到满意，76% 的患者对自己参加运动的能力感到满意。从 2 到 10 年，任何基于 MRI 的 MOCART 变量和总体 MRI 综合评分都没有发生显着变化。在 10 年时通过 MRI 检查的 151 个移植物中，有 14 个（9.3%）失败，表现为移植物分层或 MRI 扫描中没有移植组织。此外，在无法进行长期审查的 36 名患者（前瞻性招募的 204 名患者）中，7 名患者已进行全膝关节置换术，1 名患者因较早的手术而在同一股骨内侧髁部位接受了继发性 MACI 手术。移植失败。因此，22名患者（10.8%）在此期间基本上出现移植失败。在最后一次随访中，在胫股关节（相对于髌股关节）接受 MACI 的患者报告膝关节损伤和骨关节炎结果评分子量表的生活质量 ( P = .010) 以及运动和娱乐 ( P < .001) 得分明显改善，以及更大的膝伸肌强度 LSI ( P = .002)。尽管胫股组在组织填充方面表现出更好的 10 年 MOCART 评分 ( P = .027)，但没有其他基于 MRI 的差异 ( P > .05)。结论：本研究报告了一项前瞻性研究的长期回顾一系列接受 MACI 的患者，表现出良好的临床评分、高水平的患者满意度以及可接受的 10 年移植存活率。接受胫股（与髌股）MACI 治疗的患者报告了更好的长期临床结果，尽管基于 MRI 的结果基本相似。