当前位置: X-MOL 学术Am. J. Sports Med. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Autologous Chondrocyte Implantation as Treatment for Unsalvageable Osteochondritis Dissecans: 10- to 25-Year Follow-up.
The American Journal of Sports Medicine ( IF 4.8 ) Pub Date : 2020-03-17 , DOI: 10.1177/0363546520908588
James L Carey 1 , Kevin G Shea 2 , Anders Lindahl 3 , Haris S Vasiliadis 4 , Carl Lindahl 3 , Lars Peterson 3
Affiliation  

Background:

An unsalvageable osteochondritis dissecans (OCD) fragment has been defined as one that cannot be saved. Unsalvageable OCD lesions have been treated with various techniques, including fragment excision, microfracture, osteochondral autograft transfer, fresh osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI).

Hypothesis:

Patients who underwent ACI as treatment for unsalvageable OCD more than 10 years ago would maintain satisfactory patient-oriented outcome measures and have a low need for additional open surgery, especially arthroplasty.

Study Design:

Case series; Level of evidence, 4.

Methods:

All Swedish and Norwegian patients (59 patients with 67 OCD lesions) who underwent ACI for OCD under the direction of the senior author between 1990 and 2005 were identified through manual chart review. Features of the patient, OCD lesion, and surgery were extracted from the medical record and intraoperative photographs. Patients were sent questionnaires to assess the Knee injury and Osteoarthritis Outcome Score, Tegner-Wallgren activity score, and Lysholm score. In addition, patients were asked whether they had to undergo further surgery, including knee replacement, of the knee that underwent ACI. They were asked whether they would have the surgery again if in the same situation.

Results:

A total of 55 patients (93%) with 61 OCD lesions (91%) responded. The median follow-up duration was 19 years (range, 10-26 years) and the median age at follow-up was 43 years (range, 28-69 years). Subsequent arthroscopy was performed in the majority of cases, although many of these were scheduled “second looks” as part of a study. With respect to other subsequent surgery, 12 knees (20%) underwent any additional open surgery, but only 2 knees (3%) underwent arthroplasty. Eight knees (13%) underwent revision ACI. Most patients reached their preinjury activity level (62%) and would undergo ACI again if in the same situation (85%). If failure is defined as revision of the graft or conversion to arthroplasty, then survivorship after ACI for OCD in the current study would be 87% at 10 years, 85% at 15 years, and 82% at 20 years.

Conclusion:

ACI for OCD provides a durable treatment option. At a median follow-up of 19 years, there was a very low (~3%) conversion to total knee arthroplasty.



中文翻译:

自体软骨细胞植入术治疗无法挽救的骨软骨炎:10至25年的随访。

背景:

一种无法挽救的解剖性骨软骨炎(OCD)片段已被定义为无法保存的片段。无法挽救的OCD病变已通过多种技术进行了治疗,包括碎片切除,微骨折,自体软骨移植,新鲜同种异体骨软骨移植和自体软骨细胞移植(ACI)。

假设:

超过10年前接受ACI治疗无法挽救的OCD的患者将维持令人满意的以患者为导向的预后指标,并且不需要额外的开放手术,尤其是关节置换术。

学习规划:

案例系列;证据水平4。

方法:

通过手动图表审查,确定了所有在高级作者指导下于1990年至2005年接受ACD的ACD的瑞典和挪威患者(59例67个OCD病变患者)。从病历和术中照片中提取患者的特征,OCD病变和手术。向患者发送问卷以评估膝关节损伤和骨关节炎结果评分,Tegner-Wallgren活动评分和Lysholm评分。此外,询问患者是否必须对接受ACI的膝盖进行进一步的手术,包括膝关节置换。他们被问及在相同情况下是否会再次进行手术。

结果:

总共55例患者(93%)有61个OCD病变(91%)有反应。中位随访时间为19年(范围10-26岁),中位年龄为43岁(范围28-69岁)。在大多数情况下,进行了后续的关节镜检查,尽管其中许多是作为研究的一部分安排为“第二眼”。对于其他后续手术,有12膝(20%)进行了任何其他的开放性手术,但只有2膝(3%)进行了置换术。8膝(13%)接受了修订版ACI。大多数患者达到损伤前的活动水平(62%),并且在相同情况下会再次进行ACI(85%)。如果将失败定义为移植物的翻修或改用人工关节成形术,则本研究中ACD导致OCD的存活率在10年时为87%,在15年时为85%,在20年时为82%。

结论:

用于强迫症的ACI提供了持久的治疗选择。在19年的中位随访中,全膝关节置换术的转化率非常低(〜3%)。

更新日期:2020-04-03
down
wechat
bug