Per-Henrik Randsborg Ph.D., M.D. , Jan E. Brinchmann M.D., Ph.D. , Christian Owesen M.D., Ph.D. , Lars Engebretsen M.D., Ph.D. , Thomas Birkenes M.D. , Heidi Andreassen Hanvold P.T. , Jūratė Šaltytė Benth M.S., Ph.D. , Asbjørn Årøen M.D., Ph.D.
{"title":"在治疗无症状膝关节软骨损伤方面,自体软骨细胞植入并不比关节镜剥除术更好。一项随机对照试验的两年结果。","authors":"Per-Henrik Randsborg Ph.D., M.D. , Jan E. Brinchmann M.D., Ph.D. , Christian Owesen M.D., Ph.D. , Lars Engebretsen M.D., Ph.D. , Thomas Birkenes M.D. , Heidi Andreassen Hanvold P.T. , Jūratė Šaltytė Benth M.S., Ph.D. , Asbjørn Årøen M.D., Ph.D.","doi":"10.1016/j.asmr.2024.100909","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>To compare the functional and patient-reported outcome measures after autologous chondrocyte implantation (ACI) and arthroscopic debridement (AD) in symptomatic, isolated cartilage injuries larger than 2 cm<sup>2</sup> in patients aged 18 to 50 years.</p></div><div><h3>Methods</h3><p>Twenty-eight patients were included and randomized to ACI (n = 15) or AD (n = 13) and followed for 2 years. The primary outcome was the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscale.</p></div><div><h3>Results</h3><p>The mean age at inclusion was 34.1 (standard deviation [SD] 8.5) years. There were 19 (68%) male patients. The mean size of the lesion was 4.2 (SD 1.7) cm<sup>2</sup>. There was a statistically significant and clinically meaningful improvement in patient-reported outcome measures from baseline to 2 years in both groups. The improvement from baseline to final follow-up for the primary endpoint (the KOOS QoL subscale) was larger for the AD group (39.8, SD 9.4) compared with the ACI group (23.8, SD 6.7), but this difference was not statistically significant (<em>P</em> = .17). However, according to a mixed linear model there were statistically significantly greater scores in the AD group for several KOOS subscales at several time points, including KOOS QoL, KOOS pain, and KOOS sport and recreation at 2 years.</p></div><div><h3>Conclusions</h3><p>This study indicates that AD followed by supervised physiotherapy is equal to or better than ACI followed by supervised physiotherapy in patients with isolated cartilage lesions of the knee larger than 2 cm<sup>2</sup>. The improvement in KOOS QoL score from baseline to 2 years was clinically meaningful for both groups (23.8 points for ACI and 39.8 points AD), and larger for the AD group by 16 points.</p></div><div><h3>Level of Evidence</h3><p>Level I, prospective randomized controlled trial.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000270/pdfft?md5=24fab6e9c2e14b5169e9a48b1988c94b&pid=1-s2.0-S2666061X24000270-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Autologous Chondrocyte Implantation Is Not Better Than Arthroscopic Debridement for the Treatment of Symptomatic Cartilage Lesions of the Knee: Two-Year Results From a Randomized-Controlled Trial\",\"authors\":\"Per-Henrik Randsborg Ph.D., M.D. , Jan E. Brinchmann M.D., Ph.D. , Christian Owesen M.D., Ph.D. , Lars Engebretsen M.D., Ph.D. , Thomas Birkenes M.D. , Heidi Andreassen Hanvold P.T. , Jūratė Šaltytė Benth M.S., Ph.D. , Asbjørn Årøen M.D., Ph.D.\",\"doi\":\"10.1016/j.asmr.2024.100909\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>To compare the functional and patient-reported outcome measures after autologous chondrocyte implantation (ACI) and arthroscopic debridement (AD) in symptomatic, isolated cartilage injuries larger than 2 cm<sup>2</sup> in patients aged 18 to 50 years.</p></div><div><h3>Methods</h3><p>Twenty-eight patients were included and randomized to ACI (n = 15) or AD (n = 13) and followed for 2 years. The primary outcome was the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscale.</p></div><div><h3>Results</h3><p>The mean age at inclusion was 34.1 (standard deviation [SD] 8.5) years. There were 19 (68%) male patients. The mean size of the lesion was 4.2 (SD 1.7) cm<sup>2</sup>. There was a statistically significant and clinically meaningful improvement in patient-reported outcome measures from baseline to 2 years in both groups. The improvement from baseline to final follow-up for the primary endpoint (the KOOS QoL subscale) was larger for the AD group (39.8, SD 9.4) compared with the ACI group (23.8, SD 6.7), but this difference was not statistically significant (<em>P</em> = .17). However, according to a mixed linear model there were statistically significantly greater scores in the AD group for several KOOS subscales at several time points, including KOOS QoL, KOOS pain, and KOOS sport and recreation at 2 years.</p></div><div><h3>Conclusions</h3><p>This study indicates that AD followed by supervised physiotherapy is equal to or better than ACI followed by supervised physiotherapy in patients with isolated cartilage lesions of the knee larger than 2 cm<sup>2</sup>. The improvement in KOOS QoL score from baseline to 2 years was clinically meaningful for both groups (23.8 points for ACI and 39.8 points AD), and larger for the AD group by 16 points.</p></div><div><h3>Level of Evidence</h3><p>Level I, prospective randomized controlled trial.</p></div>\",\"PeriodicalId\":34631,\"journal\":{\"name\":\"Arthroscopy Sports Medicine and Rehabilitation\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-02-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2666061X24000270/pdfft?md5=24fab6e9c2e14b5169e9a48b1988c94b&pid=1-s2.0-S2666061X24000270-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroscopy Sports Medicine and Rehabilitation\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666061X24000270\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy Sports Medicine and Rehabilitation","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666061X24000270","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的比较自体软骨细胞植入术(ACI)和关节镜清创术(AD)对无症状、孤立性软骨损伤面积大于 2 平方厘米的 18 至 50 岁患者的功能和患者报告结果。主要结果是膝关节损伤和骨关节炎结果评分(KOOS)生活质量(QoL)分量表的变化。结果纳入时的平均年龄为 34.1 岁(标准差 [SD] 8.5)。男性患者有 19 人(68%)。病变的平均大小为 4.2(标准差 1.7)平方厘米。从基线到两年期间,两组患者的患者报告结果均有明显的统计学意义和临床意义的改善。与 ACI 组(23.8,SD 6.7)相比,AD 组主要终点(KOOS QoL 分量表)从基线到最终随访的改善幅度更大(39.8,SD 9.4),但这一差异在统计学上并不显著(P = .17)。然而,根据混合线性模型,AD 组在多个时间点的 KOOS 分量表得分明显高于 ACI 组,包括 2 年后的 KOOS QoL、KOOS 疼痛以及 KOOS 运动和娱乐。两组患者的KOOS QoL评分从基线到2年的改善均有临床意义(ACI改善23.8分,AD改善39.8分),AD组的改善幅度更大,达16分。
Autologous Chondrocyte Implantation Is Not Better Than Arthroscopic Debridement for the Treatment of Symptomatic Cartilage Lesions of the Knee: Two-Year Results From a Randomized-Controlled Trial
Purpose
To compare the functional and patient-reported outcome measures after autologous chondrocyte implantation (ACI) and arthroscopic debridement (AD) in symptomatic, isolated cartilage injuries larger than 2 cm2 in patients aged 18 to 50 years.
Methods
Twenty-eight patients were included and randomized to ACI (n = 15) or AD (n = 13) and followed for 2 years. The primary outcome was the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscale.
Results
The mean age at inclusion was 34.1 (standard deviation [SD] 8.5) years. There were 19 (68%) male patients. The mean size of the lesion was 4.2 (SD 1.7) cm2. There was a statistically significant and clinically meaningful improvement in patient-reported outcome measures from baseline to 2 years in both groups. The improvement from baseline to final follow-up for the primary endpoint (the KOOS QoL subscale) was larger for the AD group (39.8, SD 9.4) compared with the ACI group (23.8, SD 6.7), but this difference was not statistically significant (P = .17). However, according to a mixed linear model there were statistically significantly greater scores in the AD group for several KOOS subscales at several time points, including KOOS QoL, KOOS pain, and KOOS sport and recreation at 2 years.
Conclusions
This study indicates that AD followed by supervised physiotherapy is equal to or better than ACI followed by supervised physiotherapy in patients with isolated cartilage lesions of the knee larger than 2 cm2. The improvement in KOOS QoL score from baseline to 2 years was clinically meaningful for both groups (23.8 points for ACI and 39.8 points AD), and larger for the AD group by 16 points.