Hommen Jan Pieter, Applegate Gregory R, Del Pizzo Wilson
Orthopaedic Institute at Mercy Hospital, Miami, Florida 33133, USA.
Arthroscopy. 2007 Apr;23(4):388-93. doi: 10.1016/j.arthro.2006.11.032.
We report the results of cryopreserved meniscus allograft transplantations with 10 or more years of follow-up.
Fourteen medial and 8 lateral meniscus allografts were evaluated with a mean follow-up of 141 months (range, 115 to 167 months). The clinical outcome and failure rate was evaluated by use of a Lysholm score and modified pain score in 22 patients. The results of radiographic and magnetic resonance imaging (MRI) analysis were reported in 15 and 7 patients, respectively.
Overall, 25% of medial allografts and 50% of lateral allografts failed. The combined failure rate was 35%. There was a 90% improvement in Lysholm scores, as well as pain scores. There were no discernible Lysholm or pain score differences for both lateral and medial allografts. Furthermore, there was no discernible difference in both Lysholm and pain scores between bone plug and soft-tissue methods of graft fixation. Ten of fifteen allografts showed radiographic joint space narrowing, and twelve had progression of degenerative joint disease. On MRI, all grafts had moderate meniscus shrinkage and five had grade III signal intensities. Eighty-five percent of patients underwent subsequent procedures, 5 of whom required total allograft resection and 2 of whom required partial allograft resection. One allograft required repair.
Although transplantation of cryopreserved allografts improved knee pain and function, the average knee function was fair at long-term follow-up. Fifty-five percent of allografts failed when failure criteria for second-look surgery, knee improvement surveys, and MRI were added to Lysholm and pain score failures. The protective benefits of meniscus allografts remain debatable, and inferences cannot be made from this study.
Level IV, therapeutic case series.
我们报告了冷冻保存的半月板同种异体移植随访10年或更长时间的结果。
对14例内侧和8例外侧半月板同种异体移植进行了评估，平均随访141个月（范围115至167个月）。使用Lysholm评分和改良疼痛评分对22例患者的临床结果和失败率进行了评估。分别报告了15例和7例患者的影像学和磁共振成像（MRI）分析结果。
总体而言，25%的内侧同种异体移植和50%的外侧同种异体移植失败。综合失败率为35%。Lysholm评分和疼痛评分均有90%的改善。外侧和内侧同种异体移植的Lysholm评分或疼痛评分均无明显差异。此外，在移植物固定的骨栓法和软组织法之间，Lysholm评分和疼痛评分均无明显差异。15例同种异体移植中有10例显示影像学关节间隙变窄，12例有退行性关节病进展。在MRI上，所有移植物均有中度半月板萎缩，5例有III级信号强度。85%的患者接受了后续手术，其中5例需要进行同种异体移植全切，2例需要进行同种异体移植部分切除。1例同种异体移植需要修复。
尽管冷冻保存的同种异体移植改善了膝关节疼痛和功能，但长期随访时平均膝关节功能一般。当将二次手术的失败标准、膝关节改善调查和MRI纳入Lysholm评分和疼痛评分失败时，5�%的同种异体移植失败。半月板同种异体移植的保护益处仍存在争议，本研究无法得出推论。
IV级，治疗性病例系列。
