基质相关自体软骨细胞移植联合自体骨膜瓣治疗膝关节软骨缺损的临床疗效及基于磁共振成像的耐久性评估
简介
本研究评估了自体骨膜瓣联合基质诱导自体软骨细胞移植术（pMACI）治疗膝关节软骨缺损的长期临床效果及MRI组织耐久性。纳入17例患者（37膝），平均随访5年（范围0.1–20年），采用Lysholm评分、KOOS评分及MRI T1ρ/T2 mapping（生化评估）和MOCART 2.0（形态评估）进行评价。关键发现：20年随访时，临床评分较基线显著改善（L…
英文摘要
Objectives: To evaluate the effectiveness and durability of matrix-associated autologous chondrocyte implantation with periosteal flap (pMACI) in treating knee cartilage defects using clinical scores and MRI evaluations. Methods: Data were collected from 37 knees of 17 patients, with a mean follow-up of 5 years (range: 0.1-20 years). Clinical outcomes were assessed using the Lysholm Knee Scoring Scale (LKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Tissue quality was quantitatively evaluated using MRI T1ρ and T2 mapping (biochemical) and MR observation of cartilage repair tissue: MOCART 2.0 (morphological). A linear mixed model was used to identify factors affecting outcomes, including etiology (trauma, OCD, OA), graft site, and defect size. Results: At the 20-year follow-up, clinical scores remained significantly improved from baseline (mean LKS: 55.6 to 86.5; KOOS: 37.8 to 70.8). The biochemical MRI parameters (T1ρ and T2 values) stabilized at levels comparable to native cartilage across all etiologies and sites (p = 0.326 and 0.412, respectively), indicating stable long-term tissue quality. In contrast, the MOCART 2.0 scores significantly declined over time (annual rate: -1.14 points; p < 0.001). Etiology was a significant factor; the OA group showed significantly lower clinical and MOCART scores compared to the trauma/OCD groups (p < 0.05). However, no significant differences were found in LKS and KOOS based on graft site (p = 0.489) or defect size (p > 0.05). Conclusions: pMACI may be a highly durable treatment capable of maintaining biological tissue quality and providing clinical benefits for two decades. The observed morphological deterioration after 20 years likely reflects joint-wide aging-especially in OA cases-rather than graft failure, highlighting the importance of long-term MRI monitoring.