Objective

Osteochondral surgical procedures have been described for the treatment of unfixable osteochondritis dissecans (OCD), but only few of them have been studied for juvenile OCD (JOCD) lesions. A cell-free biomimetic osteochondral scaffold showed positive results in adult patients. The aim of this study was to evaluate the results of this scaffold for the treatment of knee JOCD at mid-term follow-up.

Design

Twenty patients (14 males, 6 females) were included in this study. Mean age was 16.2 ± 1.4 years, average defect size was 3.2 ± 1.8 cm², and mean symptoms duration was 20.2 ± 17.9 months. After the implantation of the osteochondral collagen–hydroxyapatite scaffold (Maioregen, Fin-Ceramica, Faenza, Italy), patients were evaluated preoperatively and prospectively at 1, 2, and at final mean follow-up of 6 years (range 5-7 years) with International Knee Documentation Committee (IKDC) subjective and objective, Tegner, and EuroQol visual analogue scale (VAS) scores. MRI evaluation was performed with the MOCART 2.0 score.

Results

All scores showed a significant improvement. IKDC subjective score went from 50.3 ± 17.4 preoperative score to 75.3 ± 14.6 at 1 year (P = 0.002), 80.8 ± 14.6 at 2 years and 85.0 ± 9.3 at 6 years. The Tegner score improved from the preoperative evaluation of 2.6 ± 1.4 to 5.5 ± 2.0 at 6 years (P < 0.0005), although without reaching the level registered before the onset of symptoms. A longer symptoms duration influenced negatively IKDC subjective and Tegner scores up to 2 years (P = 0.003 and P = 0.002, respectively) but did not affect the final outcome. Lesion size did not affect the final result. The MOCART 2.0 score showed a significant improvement between 1-year and final follow-up, but with persisting subchondral alterations.

Conclusions

This study demonstrated a clinical improvement stable over time with a high survival rate, although with persisting abnormal MRI findings, especially at subchondral bone level. This procedure can be considered a suitable option for the treatment of young patients affected by knee OCD. Level of evidence. Case series, level IV.

中文翻译：

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用无细胞仿生骨软骨支架治疗幼年膝关节剥脱性骨软骨炎：中期随访的临床和 MRI 结果。

客观的

骨软骨外科手术已被描述用于治疗无法固定的剥脱性骨软骨炎 (OCD)，但其中只有少数被研究用于治疗青少年强迫症 (JOCD) 病变。无细胞仿生骨软骨支架在成年患者中显示出阳性结果。本研究的目的是评估该支架在中期随访中治疗膝关节 JOCD 的结果。

设计

本研究共纳入 20 名患者（14 名男性，6 名女性）。平均年龄为 16.2 ± 1.4 岁，平均缺损大小为 3.2 ± 1.8 cm ²，平均症状持续时间为 20.2 ± 17.9 个月。在植入骨软骨胶原-羟基磷灰石支架（Maioregen，Fin-Ceramica，Faenza，意大利）后，对患者进行术前和前瞻性评估，分别为 1、2 年和最终平均随访 6 年（范围 5-7 年）国际膝关节文献委员会 (IKDC) 主观和客观、Tegner 和 EuroQol 视觉模拟量表 (VAS) 评分。MRI评估采用MOCART 2.0评分。

结果

所有分数都显示出显着的提高。IKDC 主观评分从术前的 50.3 ± 17.4 下降到 1 年的 75.3 ± 14.6（P = 0.002），2 年的 80.8 ± 14.6 和 6 年的 85.0 ± 9.3。Tegner 评分从术前评估的 2.6 ± 1.4 提高到 6 年时的 5.5 ± 2.0 ( P < 0.0005)，尽管没有达到症状发作前的水平。较长的症状持续时间对 IKDC 主观评分和 Tegner 评分产生负面影响长达 2 年（分别为P = 0.003 和P = 0.002），但不影响最终结果。病变大小不影响最终结果。MOCART 2.0 评分显示在 1 年和最终随访之间有显着改善，但软骨下改变持续存在。

结论

这项研究表明，随着时间的推移，临床改善稳定，存活率高，尽管持续存在异常的 MRI 发现，尤其是在软骨下骨水平。该程序可以被认为是治疗受膝关节强迫症影响的年轻患者的合适选择。证据水平。案例系列，IV 级。