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CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2025; 60(02): s00451809520
DOI: 10.1055/s-0045-1809520
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Tratamento de lesões condrais focais na articulação patelofemoral com membrana de colágeno: Resultados clínicos e funcionais em seguimento de dois anos

Treatment of Focal Chondral Lesions in the Patellofemoral Joint with Collagen Membrane: Clinical and Functional Outcomes in a Two-Year Follow-Up
Pedro Debieux 
1   Departamento de Cirurgia Ortopédica, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
2   Departamento de Cirurgia Ortopédica, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
3   Departamento de Cirurgia Ortopédica, Instituto Cohen, São Paulo, SP, Brasil
,
José Ricardo Dantas Moura Costa 
4   Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
,
Wesley Araujo Weis 
5   Departamento de Ortopedia, Empresa Cuiabana de Saúde Pública, Cuiabá, MT, Brasil
,
Diego da Costa Astur 
3   Departamento de Cirurgia Ortopédica, Instituto Cohen, São Paulo, SP, Brasil
4   Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
,
Camila Cohen Kaleka 
1   Departamento de Cirurgia Ortopédica, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
3   Departamento de Cirurgia Ortopédica, Instituto Cohen, São Paulo, SP, Brasil
,
Moisés Cohen 
1   Departamento de Cirurgia Ortopédica, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
3   Departamento de Cirurgia Ortopédica, Instituto Cohen, São Paulo, SP, Brasil
› Author Affiliations
Supporte Financeiro Os autores declaram que não receberam suporte financeiro de agências dos setores público, privado ou sem fins lucrativos para a realização deste estudo.
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Resumo

Objetivo

Avaliar os desfechos clínicos e funcionais de pacientes submetidos a tratamento cirúrgico para reparo de lesão condral focal na patela e na tróclea, pela técnica de condrogênese induzida por matriz autóloga (autologous matrix-induced chondrogenesis, AMIC, em inglês), após um mínimo de 2 anos de tratamento.

Métodos

Ao todo, 24 pacientes (25 joelhos) com idade média de 39,6 ± 4,7 anos foram submetidos à técnica AMIC patelofemoral e foram avaliados em um seguimento médio de 3,64 ± 0,65 anos. Os fatores dos pacientes, a morfologia da lesão e as medidas de resultado relatadas pelos pacientes, incluindo os escores do International Knee Documentation Committee (IKDC), de Tegner, de Kujala, de Fulkerson, de Lysholm, e a Escala Visual Analógica (EVA), foram coletados.

Resultados

O sexo masculino representou 76% da amostra. O tamanho médio do defeito das lesões condrais foi de 1,99 ± 0,36 cm2. Todos os defeitos foram classificados como de grau IV, de acordo com a classificação de Outerbridge. No seguimento final, os pacientes apresentaram os seguintes aumentos na pontuação média nos escores: Kujala – de 61,9 para 87,9; IKDC – de 51,3 para 83,6; Lysholm – de 64,0 para 88,4; Tegner – de 4,04 para 5,12; Fulkerson – de 60,2 para 89,3; e EVA – de 5,6 para 1,24. Todos os resultados apresentaram significância estatística (p < 0,05).

Conclusão

A AMIC é um método seguro, eficaz e viável para o tratamento de defeitos condrais sintomáticos, de espessura total da cartilagem femoropatelar, em casos adequadamente selecionados, e resultou em melhora clínica e funcional em todos os critérios analisados.

Abstract

Objective

To evaluate the clinical and functional outcomes of patients undergoing surgical treatment to repair focal chondral lesions in the patella and trochlea using the autologous matrix-induced chondrogenesis (AMIC) technique after a minimum follow-up of 2 years.

Methods

A total of 24 patients (25 knees) with a mean age of 39.6 ± 4.7 years underwent the patellofemoral AMIC technique and evaluation over a mean follow-up of 3.64 ± 0.65 years. We collected data on patient factors, lesion morphology, and patient-reported outcome measures, including the International Knee Documentation Committee (IKDC), Tegner, Kujala, Fulkerson, and Lysholm scores, as well as the Visual Analog Scale (VAS).

Results

Male subjects accounted for 76% of the sample. The mean defect size of the chondral lesions was of 1.99 ± 0.36 cm2. All defects were of grade IV according to the Outerbridge classification. At the last follow-up, patients showed the following mean increases in the scores: Kujala – from 61.9 to 87.9; IKDC –from 51.3 to 83.6; Lysholm –from 64.0 to 88.4; Tegner –from 4.04 to 5.12; Fulkerson –from 60.2 to 89.3; and VAS – from 5.6 to 1.24. All results were statistically significant (p < 0.05).

Conclusion

The AMIC technique is a safe, effective, and feasible method to treat symptomatic full-thickness chondral defects of the patellofemoral cartilage in properly-selected cases, and it resulted in clinical and functional improvement in all criteria under analysis.

Palavras-chave

cartilagem articular - condrogênese - traumatismos do joelho

Keywords

cartilage, articular - chondrogenesis - knee injuries

Consentimento Livre Esclarecido

O consentimento foi dispensado devido ao desenho do estudo.


Trabalho desenvolvido no Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.




Publication History

Received: 03 September 2024

Accepted: 07 March 2025

Article published online:
23 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Pedro Debieux, José Ricardo Dantas Moura Costa, Wesley Araujo Weis, Diego da Costa Astur, Camila Cohen Kaleka, Moisés Cohen. Tratamento de lesões condrais focais na articulação patelofemoral com membrana de colágeno: Resultados clínicos e funcionais em seguimento de dois anos. Rev Bras Ortop (Sao Paulo) 2025; 60: s00451809520.
DOI: 10.1055/s-0045-1809520
 

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