Department of Orthopaedics, Division of Sports Medicine, Cartilage Restoration Program, The Ohio State University Medical Center, Columbus, Ohio, USA.
Arthroscopy. 2011 Mar;27(3):409-18. doi: 10.1016/j.arthro.2010.08.007. Epub 2010 Oct 27.
Combined meniscal allograft transplantation (MAT) and cartilage repair or restoration is a recognized treatment for patients with painful, meniscus-deficient knees and full-thickness cartilage damage. The purpose of this systematic review was to compare outcomes after combined MAT and cartilage repair/restoration with the outcomes of isolated MAT or cartilage repair/restoration.
Multiple databases were searched with specific inclusion and exclusion criteria for clinical outcome studies after combined MAT and cartilage repair or restoration.
Six studies were identified for inclusion. In total 110 patients underwent combined MAT/cartilage repair or restoration (medial compartment in 66 and lateral compartment in 44). Patients underwent MAT and either autologous chondrocyte implantation (n = 73), osteochondral allograft (n = 20), osteochondral autograft transfer (n = 17), or microfracture (n = 3). Thirty-six patients underwent additional concurrent surgeries (high tibial or distal femoral osteotomy, cruciate or collateral ligament reconstruction, and hardware removal). All clinical outcomes were improved at final follow-up (mean, 36 months). In 4 of 6 studies, overall outcomes of combined surgery were equivalent to those of either procedure performed in isolation. In 2 studies outcomes of combined surgery were not as good as those of either procedure performed in isolation. Failure occurred in 12% of patients who underwent combined MAT and cartilage restoration, and they required revision surgery. Most failures (85%) of combined surgery were due to failure of the MAT (as opposed to the cartilage technique). One-half of all patients required at least 1 surgery after the index procedure before final follow-up.
Clinical outcomes after combined MAT and cartilage repair/restoration are similar to those after either procedure in isolation. Despite low rates of complications and failures, there is a high rate of subsequent surgery after combined MAT and cartilage repair or restoration.
Level IV, systematic review of Level IV studies.
半月板同种异体移植（MAT）联合软骨修复或重建术是治疗膝关节疼痛、半月板缺失和全层软骨损伤患者的一种公认的治疗方法。本系统评价的目的是比较 MAT 联合软骨修复/重建与单纯 MAT 或软骨修复/重建的术后结果。
使用特定的纳入和排除标准，对 MAT 联合软骨修复或重建术后的临床结局研究进行了多个数据库检索。
共纳入 6 项研究。共有 110 例患者接受了 MAT/软骨修复或重建治疗（内侧 66 例，外侧 44 例）。患者接受了 MAT 联合以下治疗方式之一：自体软骨细胞移植（n=73）、骨软骨同种异体移植（n=20）、骨软骨自体移植（n=17）或微骨折术（n=3）。36 例患者同时进行了其他手术（胫骨高位截骨或股骨远端截骨术、交叉或侧副韧带重建术和内固定取出术）。所有临床结局在最终随访时均得到改善（平均随访 36 个月）。在 6 项研究中的 4 项中，联合手术的总体结局与单独进行的任何一种手术相当。在 2 项研究中，联合手术的结局不如单独进行的任何一种手术。联合 MAT 和软骨修复的患者中有 12%发生失败，需要进行翻修手术。联合手术的大多数失败（85%）是由于 MAT 失败（而非软骨技术失败）。所有患者中有一半在最终随访前至少需要进行 1 次指数手术后的手术。
MAT 联合软骨修复/重建后的临床结局与单独进行任何一种手术的结局相似。尽管并发症和失败的发生率较低，但联合 MAT 和软骨修复或重建后仍有很高的后续手术率。
IV 级，IV 级研究的系统评价。
