Favourable clinical outcomes and low revision rate after M-ACI in adolescents with immature cartilage compared to adult controls: Results at 10 years

IF 3.3 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-07-15 DOI:10.1002/ksa.12359

Johannes Weishorn, Johanna Wiegand, Kevin-Arno Koch, Raphael Trefzer, Tobias Renkawitz, Tilman Walker, Yannic Bangert

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Abstract

Purpose

The purpose of this study was to evaluate long-term survival, patient-reported outcomes (PROs) and radiographic results of matrix-associated autologous chondrocyte implantation (M-ACI) in adolescents with immature cartilage and compare them to adult controls.

Methods

A retrospective matched-pair analysis was performed comparing the PRO after M-ACI for focal cartilage defect of the knee in cartilaginous immature adolescents to mature adults. Groups were matched for sex, body mass index, defect site and size, symptom duration and the number of previous knee surgeries. Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART 2.0) scores were assessed at least 60 months postoperatively. Patient acceptable symptomatic state (PASS) and clinical response rate in KOOS and KOOS subscores were calculated.

Results

A total of 54 patients were matched. At a mean of 96 months (65–144 months), no surgical complications, graft hypertrophy or reoperations were noted in the cohorts studied. Adolescents showed superior PROs at the final follow-up (76.9 ± 14.1 vs. 66.4 ± 15.0, p = 0.03) and were significantly more likely to achieve PASS (74.1% vs. 55.6%; p = 0.02) compared to the adult cohort. The KOOS subscale analysis showed long-term benefits for adolescents in terms of symptom improvement, pain reduction, activities of daily living, sports and quality of life (p < 0.05). None of the patients in the adolescent group showed graft hypertrophy on magnet resonance imaging or signs of osteoarthritis on radiographs at long-term follow-ups.

Conclusions

M-ACI is an effective treatment for chondral defects of the knee in patients with immature cartilage with low revision rates and high patient satisfaction over the long term. Adolescents showed comparable clinical and radiographic results in the short and medium term, with slightly more favourable, clinically relevant functional results in adolescents in the long term. M-ACI can be safely used in adolescents, and consideration should be given to expanding the indication to include these patients.

Level of Evidence

Level III.

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与成年对照组相比，软骨发育不成熟的青少年进行 M-ACI 后临床疗效好，翻修率低：10年后的结果。

目的：本研究旨在评估基质相关自体软骨细胞植入术（M-ACI）在软骨未成熟青少年中的长期存活率、患者报告结果（PROs）和影像学结果，并将其与成人对照组进行比较：我们进行了一项回顾性配对分析，比较了软骨未成熟青少年与成熟成人在接受 M-ACI 治疗膝关节局灶性软骨缺损后的 PRO。两组在性别、体重指数、缺损部位和大小、症状持续时间和膝关节手术次数等方面进行了配对。术后至少 60 个月评估膝关节损伤和骨关节炎结果评分（KOOS）和软骨修复组织磁共振观察（MOCART 2.0）评分。计算患者可接受症状状态（PASS）和 KOOS 及 KOOS 子评分的临床反应率：结果：共有 54 名患者进行了配对。在平均96个月（65-144个月）的研究中，没有发现手术并发症、移植物肥大或再次手术。与成人组相比，青少年患者在最终随访时的PROs（76.9 ± 14.1 vs. 66.4 ± 15.0，p = 0.03）更优越，且更有可能达到PASS（74.1% vs. 55.6%；p = 0.02）。KOOS 分量表分析表明，青少年在症状改善、疼痛减轻、日常生活活动、运动和生活质量等方面长期受益（p 结论：M-ACI 是一种有效的治疗方法：M-ACI 是治疗软骨未成熟患者膝关节软骨缺损的有效方法，翻修率低，患者长期满意度高。青少年患者的短期和中期临床和影像学效果相当，长期而言，青少年患者的临床相关功能效果略好。M-ACI可以安全地用于青少年，应考虑将适应症扩大到这些患者：证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).