影响基质诱导自体软骨细胞植入术后长期疗效的因素:10年的长期结果

Johannes Weishorn, Johanna Wiegand, Severin Zietzschmann, Kevin-Arno Koch, Christoph Rehnitz, Tobias Renkawitz, Tilman Walker, Yannic Bangert
{"title":"影响基质诱导自体软骨细胞植入术后长期疗效的因素:10年的长期结果","authors":"Johannes Weishorn, Johanna Wiegand, Severin Zietzschmann, Kevin-Arno Koch, Christoph Rehnitz, Tobias Renkawitz, Tilman Walker, Yannic Bangert","doi":"10.1177/03635465241270152","DOIUrl":null,"url":null,"abstract":"Background:Matrix-induced autologous chondrocyte implantation (MACI), the third-generation of the technique, is an established procedure for the treatment of focal cartilage defects in the knee. However, the literature lacks long-term results of MACI with good statistical power.Purpose:To determine long-term survival and patient-reported outcomes (PROs) in a representative cohort and to identify patient- and surgery-related parameters that may influence long-term clinical outcomes.Study Design:Case series; Level of evidence, 4.Methods:A total of 103 patients were clinically evaluated at the current follow-up of 8.1 years (range, 5-11.9 years). PRO measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score (KOOS), EQ-5D, visual analog scale for pain, and Tegner Activity Scale. Magnetic resonance imaging results were evaluated by using the AMADEUS (area measurement and depth and underlying structures) and MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 knee score classification systems. Potential factors influencing PROs were first identified univariately and investigated in a multivariate regression model.Results:The defects had a mean size of 4.8 cm<jats:sup>2</jats:sup> (range, 1.2-12 cm<jats:sup>2</jats:sup>) and were predominantly femorotibial (66%). The mean Kaplan-Meier survival rate of revision for any reason was 97.2% 6 1.6% at 10 years. In comparison to preoperative values, all PROMs were significantly improved at the current follow-up ( P &lt; .05). The MOCART 2.0 score peaked at 12 months (mean, 80.2 6 15.3 months) and showed no significant change at 96 months (mean, 76.1 ± 19.5 months; P = .142). The linear multivariate regression model identified an association of body mass index (BMI), MOCART 2.0 score, and number of previous knee surgeries with KOOS ( R<jats:sup>2</jats:sup> = 0.41; f<jats:sup>2</jats:sup> = 0.69). Further analysis of the individual determinants revealed an optimal BMI range of 20 to 29 for favorable PROs at 96 months. Significant correlations of MOCART subscores with the overall KOOS were found for graft surface and structure, bony reaction, and subchondral detectable changes. Only 30% of patients with 2 previous surgeries and 20% of patients with 3 previous surgeries achieved a Patient Acceptable Symptom State ( χ<jats:sup>2</jats:sup> = 10.93; P = .012).Conclusion:The present study shows consistently good long-term clinical outcomes after MACI with a low revision rate and high patient satisfaction. BMI and number of previous knee surgeries may influence clinical outcomes and should be considered in patient selection and education. There is a correlation between graft structure, subchondral bone changes on magnetic resonance imaging, and long-term PROMs.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Factors Influencing Long-term Outcomes After Matrix-Induced Autologous Chondrocyte Implantation: Long-term Results at 10 Years\",\"authors\":\"Johannes Weishorn, Johanna Wiegand, Severin Zietzschmann, Kevin-Arno Koch, Christoph Rehnitz, Tobias Renkawitz, Tilman Walker, Yannic Bangert\",\"doi\":\"10.1177/03635465241270152\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background:Matrix-induced autologous chondrocyte implantation (MACI), the third-generation of the technique, is an established procedure for the treatment of focal cartilage defects in the knee. However, the literature lacks long-term results of MACI with good statistical power.Purpose:To determine long-term survival and patient-reported outcomes (PROs) in a representative cohort and to identify patient- and surgery-related parameters that may influence long-term clinical outcomes.Study Design:Case series; Level of evidence, 4.Methods:A total of 103 patients were clinically evaluated at the current follow-up of 8.1 years (range, 5-11.9 years). PRO measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score (KOOS), EQ-5D, visual analog scale for pain, and Tegner Activity Scale. Magnetic resonance imaging results were evaluated by using the AMADEUS (area measurement and depth and underlying structures) and MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 knee score classification systems. Potential factors influencing PROs were first identified univariately and investigated in a multivariate regression model.Results:The defects had a mean size of 4.8 cm<jats:sup>2</jats:sup> (range, 1.2-12 cm<jats:sup>2</jats:sup>) and were predominantly femorotibial (66%). The mean Kaplan-Meier survival rate of revision for any reason was 97.2% 6 1.6% at 10 years. In comparison to preoperative values, all PROMs were significantly improved at the current follow-up ( P &lt; .05). The MOCART 2.0 score peaked at 12 months (mean, 80.2 6 15.3 months) and showed no significant change at 96 months (mean, 76.1 ± 19.5 months; P = .142). The linear multivariate regression model identified an association of body mass index (BMI), MOCART 2.0 score, and number of previous knee surgeries with KOOS ( R<jats:sup>2</jats:sup> = 0.41; f<jats:sup>2</jats:sup> = 0.69). Further analysis of the individual determinants revealed an optimal BMI range of 20 to 29 for favorable PROs at 96 months. Significant correlations of MOCART subscores with the overall KOOS were found for graft surface and structure, bony reaction, and subchondral detectable changes. Only 30% of patients with 2 previous surgeries and 20% of patients with 3 previous surgeries achieved a Patient Acceptable Symptom State ( χ<jats:sup>2</jats:sup> = 10.93; P = .012).Conclusion:The present study shows consistently good long-term clinical outcomes after MACI with a low revision rate and high patient satisfaction. BMI and number of previous knee surgeries may influence clinical outcomes and should be considered in patient selection and education. There is a correlation between graft structure, subchondral bone changes on magnetic resonance imaging, and long-term PROMs.\",\"PeriodicalId\":517411,\"journal\":{\"name\":\"The American Journal of Sports Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-09-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The American Journal of Sports Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/03635465241270152\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The American Journal of Sports Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/03635465241270152","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

背景:第三代基质诱导自体软骨细胞植入术(MACI)是治疗膝关节局灶性软骨缺损的成熟手术。研究设计:病例系列;证据等级:4。方法:在目前8.1年(5-11.9年)的随访中,共对103名患者进行了临床评估。PRO测量(PROMs)包括膝关节损伤和骨关节炎结果评分(KOOS)、EQ-5D、疼痛视觉模拟量表和Tegner活动量表。磁共振成像结果采用 AMADEUS(面积测量和深度及下层结构)和 MOCART(软骨修复组织磁共振观察)2.0 膝关节评分分类系统进行评估。结果:缺损的平均面积为4.8平方厘米(范围为1.2-12平方厘米),主要是股胫骨缺损(66%)。10年后因任何原因进行翻修的平均Kaplan-Meier存活率为97.2% 6 1.6%。与术前值相比,所有 PROMs 在本次随访中均有明显改善(P < .05)。MOCART 2.0 评分在 12 个月时达到峰值(平均值为 80.2 6 15.3 个月),96 个月时无明显变化(平均值为 76.1 ± 19.5 个月;P = .142)。线性多元回归模型确定了体重指数(BMI)、MOCART 2.0 评分和膝关节既往手术次数与 KOOS 的关系(R2 = 0.41;f2 = 0.69)。对各个决定因素的进一步分析表明,最佳体重指数范围为20至29,96个月后的PROs结果会更理想。在移植物表面和结构、骨反应以及软骨下可检测到的变化方面,MOCART 子评分与总体 KOOS 存在显著相关性。只有 30% 曾接受过 2 次手术的患者和 20% 曾接受过 3 次手术的患者达到了患者可接受的症状状态(χ2 = 10.93; P = .012)。体重指数(BMI)和既往膝关节手术次数可能会影响临床疗效,在选择和教育患者时应加以考虑。移植物结构、磁共振成像显示的软骨下骨变化与长期PROMs之间存在相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Factors Influencing Long-term Outcomes After Matrix-Induced Autologous Chondrocyte Implantation: Long-term Results at 10 Years
Background:Matrix-induced autologous chondrocyte implantation (MACI), the third-generation of the technique, is an established procedure for the treatment of focal cartilage defects in the knee. However, the literature lacks long-term results of MACI with good statistical power.Purpose:To determine long-term survival and patient-reported outcomes (PROs) in a representative cohort and to identify patient- and surgery-related parameters that may influence long-term clinical outcomes.Study Design:Case series; Level of evidence, 4.Methods:A total of 103 patients were clinically evaluated at the current follow-up of 8.1 years (range, 5-11.9 years). PRO measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score (KOOS), EQ-5D, visual analog scale for pain, and Tegner Activity Scale. Magnetic resonance imaging results were evaluated by using the AMADEUS (area measurement and depth and underlying structures) and MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 knee score classification systems. Potential factors influencing PROs were first identified univariately and investigated in a multivariate regression model.Results:The defects had a mean size of 4.8 cm2 (range, 1.2-12 cm2) and were predominantly femorotibial (66%). The mean Kaplan-Meier survival rate of revision for any reason was 97.2% 6 1.6% at 10 years. In comparison to preoperative values, all PROMs were significantly improved at the current follow-up ( P < .05). The MOCART 2.0 score peaked at 12 months (mean, 80.2 6 15.3 months) and showed no significant change at 96 months (mean, 76.1 ± 19.5 months; P = .142). The linear multivariate regression model identified an association of body mass index (BMI), MOCART 2.0 score, and number of previous knee surgeries with KOOS ( R2 = 0.41; f2 = 0.69). Further analysis of the individual determinants revealed an optimal BMI range of 20 to 29 for favorable PROs at 96 months. Significant correlations of MOCART subscores with the overall KOOS were found for graft surface and structure, bony reaction, and subchondral detectable changes. Only 30% of patients with 2 previous surgeries and 20% of patients with 3 previous surgeries achieved a Patient Acceptable Symptom State ( χ2 = 10.93; P = .012).Conclusion:The present study shows consistently good long-term clinical outcomes after MACI with a low revision rate and high patient satisfaction. BMI and number of previous knee surgeries may influence clinical outcomes and should be considered in patient selection and education. There is a correlation between graft structure, subchondral bone changes on magnetic resonance imaging, and long-term PROMs.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信