Zusammenfassung
Objective Repair of localized cartilage defects in the knee. Indications Localized partial or full-thickness cartilage defects in the knee or osteochondral lesions (osteochondritis dissecans (OD]). Contraindications Generalized cartilage defects, osteoarthritis, bacterial and rheumatoid arthritis, uncorrected axis deformities, ligament instability, patella instability, meniscectomy. Surgical ...
Zusammenfassung
Objective Repair of localized cartilage defects in the knee. Indications Localized partial or full-thickness cartilage defects in the knee or osteochondral lesions (osteochondritis dissecans (OD]). Contraindications Generalized cartilage defects, osteoarthritis, bacterial and rheumatoid arthritis, uncorrected axis deformities, ligament instability, patella instability, meniscectomy. Surgical Technique Two-step procedure. 1. Diagnostic arthroscopy and cartilage biopsy for cell cultivation. 2. Minimalized arthrotomy. Defect debridement. Autologous cancellous bone grafting in OD. Glueing of the cell-loaded scaffold into the defect. Postoperative Management Early functional rehabilitation with knee orthosis. Partial weight bearing (20 kg) for 6 weeks. Results 50 patients (24 female, 26 male, age 14-44years, mean 30.3 years) with 58 focal cartilage defects (III-IV degrees) of the knee in the medial (n = 32) or lateral condyle (n = 5), patella (n = 14) and/or trochlea (n = 7) underwent matrix-associated autologous chondrocyte implantation (MACI (R)). The mean follow-up was 24 months (21-29 months). The mean defect size was 4.1 cm(2) (1.6-6.1 cm(2)). The Lysholm Score improved from 57.3 to 87.4 points,the DGKKT (German Society of Autologous Cartilage and Bone Cell Transplantation) Score from 55.3 to 85.5 points. Pain on a visual analog scale (VAS) diminished from 5.5 to 2.1, while subjective function enhanced from 4.5 to 7.6. All scores were significant (p < 0.01; t-test). In eleven patients (twelve defects), a second-look arthroscopy revealed a mostly fibrocartilaginous regenerative tissue in 41.7% (5/12) and a mixed fibrous/hyaline regenerative tissue in 33.4% (4/12). 54% (27/50) of the patients estimated their result as excellent, 28% (14/50) as good, 16% as fair, and 2% (1/50) as poor.
Altmetric