Objective

To compare the efficacy and safety of costal chondrocyte–derived pellet-type autologous chondrocyte implantation (CCP-ACI) with microfracture (MFx) for repair of articular cartilage defects of the knee.

Design

Thirty subjects with an International Cartilage Repair Society (ICRS) grade 3 to 4 chondral defect (2-10 cm² in area; ≤4 cm³ in volume) were randomized at a ratio of 2:1 (CCP-ACI:MFx). Twenty patients were allocated in the CCP-ACI group and 10 patients in the MFx group. CCP-ACI was performed by harvesting costal cartilage at least 4 weeks before surgery. Implantation was performed without any marrow stimulation. Efficacy and safety were assessed at weeks 8, 24, and 48 after surgery according to the magnetic resonance observation of cartilage repair tissue (MOCART) score and clinical outcomes.

Results

MOCART scores improved from baseline to 24 and 48 weeks postoperatively in both treatment groups. The improvement in MOCART scores in the CCP-ACI group was significantly greater than that in the MFx group at 24 and 48 weeks (39.1 vs 21.8 and 43.0 vs 24.8, respectively). The proportions of complete defect repair and complete integration were significantly higher in the CCP-ACI group than the MFx group at 48 weeks. Improvement in Lysholm score and KOOS subscores, including Function (Sports and Recreational Activity) and knee-related quality of life was significantly greater in the CCP-ACI group than the MFx group at 48 weeks (35.4 vs 31.5, 35.7 vs 28.5, and 27.9 vs 11.6, respectively).

Conclusion

Treatment of cartilage defects with CCP-ACI yielded satisfactory cartilage tissue repair outcomes, with good structural integration with native cartilage tissue shown by magnetic resonance imaging at 24 and 48 weeks after surgery.

Level of Evidence

Level 1: Randomized controlled study.

中文翻译：

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肋软骨细胞来源的颗粒型自体软骨细胞植入与微骨折修复关节软骨缺损：一项前瞻性随机试验。

客观的

比较肋软骨细胞来源的颗粒型自体软骨细胞植入（CCP-ACI）与微骨折（MFx）修复膝关节软骨缺损的疗效和安全性。

设计

30 名患有国际软骨修复协会 (ICRS) 3 至 4 级软骨缺损（面积 2-10 cm ²；体积≤4 cm ³）的受试者以 2:1 (CCP-ACI:MFx) 的比例随机分组。20 名患者被分配到 CCP-ACI 组，10 名患者被分配到 MFx 组。CCP-ACI 通过在手术前至少 4 周采集肋软骨进行。在没有任何骨髓刺激的情况下进行植入。根据软骨修复组织的磁共振观察（MOCART）评分和临床结果在术后第8、24和48周评估疗效和安全性。

结果

两个治疗组的 MOCART 评分从基线改善到术后 24 周和 48 周。在 24 周和 48 周时，CCP-ACI 组 MOCART 评分的改善显着高于 MFx 组（分别为 39.1 vs 21.8 和 43.0 vs 24.8）。在 48 周时，CCP-ACI 组的完全缺陷修复和完全整合的比例显着高于 MFx 组。在 48 周时，CCP-ACI 组的 Lysholm 评分和 KOOS 子评分（包括功能（运动和娱乐活动）和膝关节相关生活质量）的改善显着高于 MFx 组（35.4 vs 31.5、35.7 vs 28.5 和 27.9分别与 11.6 相比）。

结论

用 CCP-ACI 治疗软骨缺损产生了令人满意的软骨组织修复结果，在手术后 24 周和 48 周，磁共振成像显示与天然软骨组织具有良好的结构整合。

证据水平

1级：随机对照研究。