Toronto Western Hospital and Women's College Hospital, Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada.
Arthroscopy. 2013 Mar;29(3):575-88. doi: 10.1016/j.arthro.2012.12.002.
The objectives of this study were (1) to conduct a systematic review of clinical outcomes after osteochondral allograft transplantation in the knee and (2) to identify patient-, defect-, and graft-specific prognostic factors.
We searched PubMed, Medline, EMBASE, and the Cochrane Central Register of Controlled Trials. Studies that evaluated clinical outcomes in adult patients after osteochondral allograft transplantation for chondral defects in the knee were included. Pooled analyses for pertinent continuous and dichotomous variables were performed where appropriate.
There were 19 eligible studies resulting in a total of 644 knees with a mean follow-up of 58 months (range, 19 to 120 months). The overall follow-up rate was 93% (595 of 644). The mean age was 37 years (range, 20 to 62 years), and 303 patients (63%) were men. The methods of procurement and storage time included fresh (61%), prolonged fresh (24%), and fresh frozen (15%). With regard to etiology, the most common indications for transplantation included post-traumatic (38%), osteochondritis dissecans (30%), osteonecrosis from all causes (12%), and idiopathic (11%). Forty-six percent of patients had concomitant procedures, and the mean defect size across studies was 6.3 cm(2). The overall satisfaction rate was 86%. Sixty-five percent of patients (72 of 110) showed little to no arthritis at final follow-up. The reported short-term complication rate was 2.4%, and the overall failure rate was 18%. Heterogeneity in functional outcome measures precluded a meta-analysis; a qualitative synthesis allowed for the identification of several positive and negative prognostic factors.
Osteochondral allograft transplantation for focal and diffuse (single-compartment) chondral defects results in predictably favorable outcomes and high satisfaction rates at intermediate follow-up. Patients with osteochondritis dissecans and traumatic and idiopathic etiologies have more favorable outcomes, as do younger patients with unipolar lesions and short symptom duration. Future studies should include comparative control groups and use established outcome instruments that will allow for pooling of data across studies.
Level IV, systematic review of Level IV studies.
本研究的目的是：（1）系统回顾膝关节骨软骨同种异体移植术后的临床结果；（2）确定患者、缺陷和移植物的特定预后因素。
我们检索了 PubMed、Medline、EMBASE 和 Cochrane 对照试验中心注册库。纳入评估膝关节软骨缺损行骨软骨同种异体移植后成年患者临床结果的研究。在适当情况下，对相关连续和二分变量进行了汇总分析。
共有 19 项符合条件的研究，共纳入 644 例膝关节，平均随访时间为 58 个月（范围 19 至 120 个月）。总的随访率为 93%（595/644）。平均年龄为 37 岁（范围 20 至 62 岁），303 例患者（63%）为男性。采集和储存时间的方法包括新鲜（61%）、延长新鲜（24%）和新鲜冷冻（15%）。就病因而言，最常见的移植适应证包括创伤后（38%）、剥脱性骨软骨炎（30%）、各种原因导致的骨坏死（12%）和特发性（11%）。46%的患者进行了联合手术，研究中平均缺陷大小为 6.3cm2。总体满意度为 86%。72 例（110 例中的 65%）患者在最终随访时表现出轻微至无关节炎。报告的短期并发症发生率为 2.4%，总失败率为 18%。由于功能结果测量的异质性，无法进行荟萃分析；定性综合允许确定几个阳性和阴性的预后因素。
骨软骨同种异体移植治疗局灶性和弥漫性（单室）软骨缺损可获得可预测的良好结果和高满意度，在中期随访时。剥脱性骨软骨炎和创伤性及特发性病因患者的结果更有利，年轻患者的单极病变和症状持续时间较短的患者也是如此。未来的研究应包括对照研究，并使用既定的结果评估工具，以便在研究间汇总数据。
四级，四级研究的系统评价。
