关节镜测量比磁共振成像更准确地预测膝关节软骨病变大小，损伤机制影响两种技术预测移植物大小的能力

Q3 Medicine Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-08-01 DOI:10.1016/j.asmr.2024.100951

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摘要

目的比较磁共振成像（MRI）和关节镜检查以及骨软骨异体移植（OCA）或自体软骨细胞植入（ACI）时的骨软骨缺损大小测量和特征。方法回顾性鉴定2015年至2019年期间在一家机构接受ACI和OCA移植的患者。如果患者患有严重的骨关节炎、核磁共振成像扫描无法进行复查、手术记录不包括分析所需的缺损大小或无法获得手术报告，则将其排除在外。术前通过核磁共振成像和关节镜检查收集骨软骨病变特征（包括大小），并在进行明确的开放手术干预时收集这些特征。根据所采用的矫正手术方法以及软骨损伤的机制，对测量技术进行了分组分析比较，以确定这些因素是否会影响关节镜或核磁共振成像预测移植物大小的能力。结果共处理了136处软骨损伤，对117名患者（平均年龄32.5岁）进行了修复手术。最终移植物大小与指数关节镜测量的病变面积之间的平均差异为 116 平方毫米，而最终移植物大小与术前核磁共振成像测量的病变面积之间的平均差异为 182 平方毫米（P < .001）。根据手术技术的不同，当患者接受OCA移植与ACI移植时，MRI测量结果与最终移植物大小更为接近（P = .007）。结论术前磁共振成像确定的软骨病变大小不如关节镜测量准确。导致软骨损伤的损伤机制和损伤程度可能会影响核磁共振成像和关节镜准确测量软骨病变和预测手术矫正中使用的最终移植物大小的能力。

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Arthroscopic Measurements Predict Knee Chondral Lesion Size More Accurately Than Magnetic Resonance Imaging, and Mechanism of Injury Influences Ability of Either Technique to Predict Graft Size

Purpose

To compare osteochondral defect size measurements and characteristics across magnetic resonance imaging (MRI) and arthroscopy and at the time of osteochondral allograft (OCA) transplantation or autologous chondrocyte implantation (ACI).

Methods

Patients who underwent ACI and OCA transplantation at a single institution between 2015 and 2019 were retrospectively identified. Patients were excluded if they had severe osteoarthritis, MRI scans were not available for review, surgical records did not include defect sizing necessary for analysis, or operative reports were not available. Osteochondral lesion characteristics including size were collected preoperatively by MRI and arthroscopy and at the time of definitive open surgical intervention. Subgroup analysis was performed comparing measurement techniques depending on the corrective surgical approach used, as well as depending on the mechanism of chondral injury, to determine whether these factors had any effect on the ability of arthroscopy or MRI to predict graft size.

Results

Overall, 136 chondral lesions were addressed, with restoration procedures in 117 patients (mean age, 32.5 years). The average difference between the final graft size and the lesion area measured with index arthroscopy was 116 mm², whereas the average difference between the final graft size and the lesion size measured with preoperative MRI was 182 mm² (P < .001). Depending on surgical technique, measurements with MRI were more similar to the final graft size when a patient underwent OCA transplantation versus ACI (P = .007). Depending on the mechanism of injury, MRI measurements of lesions were closer to the graft area when lesions resulted from trauma (P = .047).

Conclusions

Chondral lesion size as determined by preoperative MRI is less accurate than arthroscopic measurement. The mechanism of injury leading to chondral damage and degree of damage may influence the ability of MRI and arthroscopy to accurately measure chondral lesions and predict the final graft size used in surgical correction.