CCP-ACI on OCD up to 10mm

<b>Purpose: </b>To evaluate clinical, radiographic, and magnetic resonance (MR) results of costal chondrocyte-derived pellet-type scaffold-free autologous chondrocyte implantation (CCP-ACI) in osteochondral defects (ODs) up to 10-mm depth during 5 years of follow-up.<b>Methods: </b>Ten patients with CCP-ACI performed in ODs with depth up to 10 mm were retrospectively analyzed. The minimum follow-up period was 5 years. The median age was 36.5 (range, 20–55) years. The median size and depth of the OD lesion were 4.25 cm² (range, 2–6) and 7.0 mm (6–9), respectively. Clinically, the International Knee Documentation Committee, Lysholm, and visual analog scale pain scores were evaluated. Radiographically, the hip‒knee‒ankle (HKA) angle and the Kellgren‒Lawrence (K‒L) grade were assessed. On MR imaging, the magnetic resonance observation of cartilage repair tissue (MOCART) 2.0 score and defect depth were evaluated.<b>Results: </b>All average clinical scores improved significantly by 1, 2, and 5 years postoperatively. The average HKA angle and the proportion of K‒L grade did not change significantly within 5 years. The median total MOCART scores were 50 (range, 45–65), 50 (35–90), 57.5 (40–90), and 65 (50–85) at 6 months, 1 year, 2 years, and 5 years postoperatively, respectively (p = 0.001), with significant improvement at 2 years compared to that at 6 months postoperatively. The signal intensity of the repair tissue and subchondral change significantly improved from 10 (range, 10–10) to 12.5 (10–15) (p = 0.036), and from 10 (10–10) to 17.5 (0–20) (p = 0.017), respectively. Significant improvements were seen at 5 years postoperatively for the former and at 2 years postoperatively for the latter. The average depths on MR imaging were 6.7, 6.7, 6.8, 6.6, and 6.6 mm preoperatively and at 6 months, 1 year, 2 years, and 5 years postoperatively with no significant changes (n.s)<b>Conclusion: </b>CCP-ACI provided acceptable mid-term outcomes in ODs up to 10-mm in depth without bone grafting despite of no scaffold. The procedure can be one of minimally invasive treatment options for ODs without scaffold-related problems.

<b>研究目的：</b>本研究旨在评估肋软骨细胞来源的无支架微球型自体软骨细胞移植（CCP-ACI）用于深度≤10mm骨软骨缺损（ODs）时，为期5年随访的临床、影像学及磁共振（MR）结局。<b>研究方法：</b>本研究回顾性分析了10例接受CCP-ACI治疗的骨软骨缺损患者，其缺损深度均≤10mm，最短随访时长为5年。患者的中位年龄为36.5岁（范围：20~55岁），骨软骨缺损病灶的中位面积为4.25 cm²（范围：2~6 cm²），中位深度为7.0 mm（范围：6~9 mm）。临床评估指标包括国际膝关节文献委员会评分、Lysholm评分及视觉模拟疼痛评分；影像学评估指标包括髋-膝-踝（HKA）角及凯尔格伦-劳伦斯（K-L）分级；磁共振成像评估指标包括软骨修复组织磁共振观察（MOCART）2.0评分与缺损深度。<b>研究结果：</b>术后1、2及5年时，所有临床评分的平均值均显著提升。术后5年内，患者的平均HKA角与K-L分级占比无显著变化。术后6个月、1年、2年及5年时，总MOCART评分的中位值分别为50（范围：45~65）、50（范围：35~90）、57.5（范围：40~90）及65（范围：50~85）（p=0.001），其中术后2年的评分较术后6个月时显著提升。修复组织的信号强度及软骨下骨改变分别从基线的10（范围：10~10）显著改善至12.5（范围：10~15）（p=0.036）与17.5（范围：0~20）（p=0.017）；前者的显著改善见于术后5年，后者则见于术后2年。术前及术后6个月、1年、2年、5年的磁共振成像缺损平均深度分别为6.7、6.7、6.8、6.6及6.6 mm，无显著变化（无统计学意义）。<b>研究结论：</b>尽管无需支架且无需植骨，CCP-ACI用于深度≤10mm的骨软骨缺损时，可获得可接受的中期临床结局。该术式可作为无需处理支架相关问题的骨软骨缺损微创治疗方案之一。