术前磁共振成像显示的受伤膝关节半月板和软骨状况是影响膝关节软骨修复手术术后效果的预后因素之一

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-12-01 DOI:10.1016/j.asmr.2024.100973

Dai Sato M.D., Ph.D. , Rawee Manatrakul M.D. , Chotigar Ngarmsrikam M.D. , Brian T. Feeley M.D. , C. Benjamin Ma M.D. , Thomas M. Link M.D. , Drew A. Lansdown M.D.

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引用次数: 0

摘要

目的探讨膝关节术前全关节影像学评价与软骨修复手术（软骨嵌合成形术、同种异体骨软骨移植、基质自体软骨细胞植入）后患者报告预后（PRO）措施的关系。方法回顾性分析2014年至2020年在我院行膝关节软骨修复术的患者。采用全器官磁共振成像评分（WORMS）和术前MRI滑膜炎症半定量成像生物标志物对患者的膝关节磁共振成像（MRI）进行评估。为了评估PRO评分，Lysholm评分和膝关节损伤和骨关节炎结局评分在至少2年的随访中完成。采用Spearman秩检验进行统计分析，获得每次调查的WORMS评分和PRO评分的相关值。结果40例患者入组。基线时平均年龄为34.5岁。平均身体质量指数为28.2，其中男性26例（年龄20-58岁）。术前最高WORMS评分与术后Lysholm评分显著相关（r = -0.52, P = 0.0013）。WORMS半月板和软骨亚量表与Lysholm评分显著相关（r = -0.36, P = 0.024和r = -0.37, P = 0.021）。最高WORMS评分与膝关节损伤和骨关节炎预后评分日常生活和运动/娱乐评分显著相关（r = -0.47, P = 0.0023和r = -0.42, P = 0.0077）。半定量滑膜炎症成像生物标志物与PRO评分无显著相关性。结论术前膝关节退行性改变增加，如术前MRI较高的WORMS所证明的，与软骨修复手术（嵌合成形术、同种异体骨软骨移植、基质自体软骨细胞植入）后至少2年患者报告的不良预后相关。在术前MRI上对整个关节进行半定量评分，可以改善对软骨修复手术后患者预期获益的咨询。证据级别：IV级，预后病例系列。

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The Condition of the Meniscus and Cartilage of the Injured Knee on Preoperative Magnetic Resonance Imaging Is a Prognostic Factor Affecting Postoperative Outcomes Following Knee Cartilage Restoration Surgery

Purpose

To evaluate the relationship between preoperative whole-joint imaging evaluation of the knee with patient-reported outcome (PRO) measures after cartilage restoration surgery (mosaicplasty, osteochondral allograft transplantation, matrix autologous chondrocyte implantation).

Methods

We retrospectively evaluated patients who underwent knee articular cartilage restoration at our institution from 2014 to 2020. The patients’ knee magnetic resonance imaging (MRI) was evaluated with the Whole-Organ Magnetic Resonance Imaging Score (WORMS) and semiquantitative synovial inflammation imaging biomarkers of the preoperative MRI. To assess PRO score, Lysholm score and Knee injury and Osteoarthritis Outcome Score were completed at a minimum 2-year follow-up. Statistical analysis was performed using the Spearman rank test to obtain correlation values for WORMS score and PRO score for each survey.

Results

Forty patients were enrolled in this study. The average age at baseline was 34.5 years. The average body mass index was 28.2, and 26 of 40 were men (age range, 20-58 years). The maximum preoperative WORMS score was significantly correlated with the postoperative Lysholm score (r = –0.52, P = .0013). The WORMS Meniscus and Cartilage subscales were significantly correlated with the Lysholm score (r = –0.36, P = .024 and r = –0.37, P = .021, respectively). The maximum WORMS score was significantly correlated with the Knee injury and Osteoarthritis Outcome Score daily living and sports/recreation subscores (r = –0.47, P = .0023 and r = –0.42, P = .0077, respectively). Semiquantitative synovial inflammation imaging biomarkers were not significantly correlated with PRO scores.

Conclusions

Increasing preoperative degenerative change in the knee, as evidenced by a higher WORMS on preoperative MRI, was associated with inferior patient-reported outcomes at a minimum of 2 years after cartilage restoration surgery (mosaicplasty, osteochondral allograft transplantation, matrix autologous chondrocyte implantation). Semiquantitative scoring of the whole joint on preoperative MRI may allow for improved counseling regarding expected benefit for patients after cartilage restoration surgery.