CCP-ACI on OCD up to 10mm

Purpose: 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.Methods: 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.Results: 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)Conclusion: 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.

目的：本研究旨在评估长达5年随访期间，用于深度达10mm的骨软骨缺损（osteochondral defects, ODs）的肋软骨来源颗粒型无支架自体软骨细胞植入术（costal chondrocyte-derived pellet-type scaffold-free autologous chondrocyte implantation, CCP-ACI）的临床、影像学及磁共振（magnetic resonance, MR）相关结局。
方法：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，缺损深度均不超过10mm，最短随访时长为5年。患者中位年龄为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评分及视觉模拟量表（visual analog scale, VAS）疼痛评分；影像学评估指标包括髋-膝-踝角（hip-knee-ankle, HKA）及Kellgren-Lawrence（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评分2.0版（magnetic resonance observation of cartilage repair tissue 2.0, MOCART 2.0）及缺损深度。
结果：术后1年、2年及5年的各项临床平均评分均较术前显著改善。术后5年内，患者的平均HKA角及K-L分级占比均无显著变化。术后6个月、1年、2年及5年的中位MOCART总评分分别为50分（范围45~65分）、50分（范围35~90分）、57.5分（范围40~90分）及65分（范围50~85分）（p=0.001），术后2年的评分较术后6个月显著提升。修复组织信号强度评分从术前的10分（范围10~10分）提升至12.5分（范围10~15分）（p=0.036），软骨下骨改变评分从术前的10分（范围10~10分）提升至17.5分（范围0~20分）（p=0.017）；前者在术后5年出现显著改善，后者在术后2年出现显著改善。术前、术后6个月、1年、2年及5年的磁共振成像下缺损平均深度分别为6.7 mm、6.7 mm、6.8 mm、6.6 mm及6.6 mm，无显著统计学差异。
结论：针对深度达10mm的骨软骨缺损，CCP-ACI无需植骨且未使用支架，可获得良好的中期临床结局，且不存在支架相关问题。该术式可作为骨软骨缺损的微创治疗可选方案之一。