Background:A few studies have documented the long-term results of chondrocyte-based procedures for the treatment of patellofemoral cartilage lesions, but specific results are lacking after matrix-assisted autologous chondrocyte transplantation (MACT) for patellar and trochlear lesions.Purpose:To document the clinical results of MACT for the treatment of patellar and trochlear chondral defects at long-term follow-up.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 44 patients were prospectively evaluated after MACT for patellofemoral lesions. There were 24 patients affected by patellar lesions, 16 by trochlear lesions, and 4 with both patellar and trochlear defects. Clinical outcomes were analyzed using the International Knee Documentation Committee (IKDC) subjective form, EuroQol visual analog scale, and Tegner score for sport activity level before surgery and at follow-up time points of 5, 10, and a minimum of 15 years (mean final follow-up, 17.6 ± 1.6 years). A Kaplan-Meier survival analysis was performed to examine the survival to failure. Failure was defined as the need for a second surgery because of the persistence of symptoms related to the primary defect.Results:An overall significant improvement was documented from baseline to the last follow-up. The IKDC subjective score improved in the trochlear group from 41.0 ± 13.3 at baseline to 83.9 ± 21.6 at 5 years ( P < .005), remaining stable up to the final follow-up (81.3 ± 20.5). In the patellar group, the IKDC subjective score improved from 36.1 ± 14.4 at baseline to 72.3 ± 17.5 at 5 years ( P < .005), remaining stable up to the final follow-up (62.0 ± 20.3). Patients with trochlear lesions presented higher IKDC subjective scores compared with those with patellar lesions at 5 ( P = .029), 10 ( P = .023), and ≥15 years ( P = .006) of follow-up. Similar trends were documented for the Tegner score, while no differences were documented for the EuroQol visual analog scale score between patellar and trochlear lesions. There were 4 failures (9.1%) during the follow-up period. The Kaplan-Meier survival analysis did not show statistically significant differences between trochlear and patellar lesions.Conclusion:This hyaluronic acid–based MACT technique offered positive and durable clinical outcomes with a low failure rate at long-term follow-up in patients affected by patellofemoral cartilage lesions. However, trochlear and patellar lesions demonstrated a notable difference in terms of clinical findings and sport activity level, with significantly higher results for patients with trochlear lesions but less satisfactory outcomes for patients with patellar lesions.

中文翻译：

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基质辅助自体软骨细胞移植治疗髌股软骨损伤：至少 15 年随访的长期结果


背景：一些研究记录了基于软骨细胞的手术治疗髌股软骨病变的长期结果，但基质辅助自体软骨细胞移植（MACT）治疗髌骨和滑车病变后缺乏具体结果。目的：记录长期随访中MACT治疗髌骨和滑车软骨缺损的临床结果。研究设计：队列研究；证据级别，3。方法：MACT 后对总共 44 名患者的髌股病变进行前瞻性评估。髌骨病变 24 例，滑车病变 16 例，髌骨和滑车同时缺损 4 例。使用国际膝关节文献委员会 (IKDC) 主观形式、EuroQol 视觉模拟量表和术前运动活动水平 Tegner 评分以及 5、10 和至少 15 年的随访时间点（平均最终随访，17.6 ± 1.6 年）。进行 Kaplan-Meier 生存分析来检查生存至失败的情况。失败被定义为由于与主要缺陷相关的症状持续存在而需要进行第二次手术。结果：从基线到最后一次随访，记录了总体显着改善。滑车组的 IKDC 主观评分从基线时的 41.0 ± 13.3 提高到 5 年时的 83.9 ± 21.6 ( P < .005)，直至最终随访时保持稳定 (81.3 ± 20.5)。在髌骨组中，IKDC 主观评分从基线时的 36.1 ± 14.4 提高到 5 年时的 72.3 ± 17.5 ( P < .005)，直至最终随访时保持稳定 (62.0 ± 20.3)。与髌骨病变患者相比，滑车病变患者的 IKDC 主观评分更高（P = .029)、10 (P = .023) 和≥15 年 (P = .006) 的随访。 Tegner 评分记录了类似的趋势，而髌骨和滑车病变之间的 EuroQol 视觉模拟量表评分没有记录差异。随访期间失败4例（9.1%）。 Kaplan-Meier 生存分析未显示滑车和髌骨病变之间存在统计学显着差异。结论：这种基于透明质酸的 MACT 技术为受髌股关节损伤的患者提供了积极且持久的临床结果，且长期随访失败率较低软骨病变。然而，滑车和髌骨病变在临床表现和运动水平方面表现出显着差异，滑车病变患者的结果明显较高，但髌骨病变患者的结果不太令人满意。