Yabumoto Hiromitsu, Nakagawa Yasuaki, Mukai Shogo, Saji Takahiko, Nakamura Takashi
Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fukakusa, Fushimi-ku, Kyoto, Japan.
Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fukakusa, Fushimi-ku, Kyoto, Japan.
Arthroscopy. 2017 Jun;33(6):1241-1247. doi: 10.1016/j.arthro.2017.01.026. Epub 2017 Mar 18.
To present the surgical technique, clinical outcomes, and poor prognostic factors of arthroscopic retrograde osteochondral autograft transfer of the tibial plateau.
Twelve patients (6 men, 6 women; mean age, 38.7 years) with tibial plateau osteochondral lesions underwent surgery. The primary diseases were osteonecrosis in 4 cases, cartilage injuries in 6, and postfractures of the tibial plateau in 2. Clinical outcomes were evaluated preoperatively and postoperatively according to the International Knee Documentation Committee score and the Japanese Orthopaedic Association score. The International Cartilage Repair Society score was recorded in 7 cases who underwent second-look arthroscopies postoperatively. Statistical analyses were performed to identify prognostic factors associated with the clinical outcomes.
The mean International Knee Documentation Committee and Japanese Orthopaedic Association scores were both significantly improved from 39.0 (range, 13.0-57.1) to 72.4 (range, 33.3-100) (P = .0022) and from 65.8 (range, 30.0-85.0) to 85.8 (range, 50.0-100) (P = .0022 < .05), respectively. In 2 cases, secondary operations were performed because of knee pain (1 varus osteotomy of the femur and 1 total knee replacement). The mean International Cartilage Repair Society scores were significantly worse in the 2 cases who required a secondary operation (3.5; abnormal) than in the 5 cases who did not (10.6; nearly normal). The secondary operation rate was significantly higher in cases with lesion size ≥400 mm than in those <400 mm (Fisher's exact test; P = .046).
Most clinical scores improved significantly postoperatively. The results indicate that arthroscopic retrograde osteochondral autograft transfer is an effective procedure to achieve sufficient cartilage congruity for osteochondral lesions of the tibial plateau <400 mm in size.
Level IV, therapeutic case series.
介绍关节镜下逆行自体骨软骨移植治疗胫骨平台损伤的手术技术、临床疗效及不良预后因素。
12例（男6例，女6例；平均年龄38.7岁）胫骨平台骨软骨损伤患者接受手术治疗。原发性疾病包括骨坏死4例，软骨损伤6例，胫骨平台骨折后2例。术前和术后根据国际膝关节文献委员会（IKDC）评分和日本骨科协会（JOA）评分评估临床疗效。7例术后接受二次关节镜检查的患者记录了国际软骨修复协会（ICRS）评分。进行统计分析以确定与临床疗效相关的预后因素。
IKDC评分和JOA评分的平均值均显著提高，分别从39.0（范围13.0 - 57.1）提高到72.4（范围33.3 - 100）（P = 0.0022），从65.8（范围30.0 - 85.0）提高到85.8（范围50.0 - 100）（P = 0.0022 < 0.05）。2例患者因膝关节疼痛接受了二次手术（1例股骨内翻截骨术和1例全膝关节置换术）。需要二次手术的2例患者的ICRS评分平均值（3.5；异常）明显低于未进行二次手术的5例患者（10.6；接近正常）。病变大小≥400 mm的患者二次手术率显著高于<400 mm的患者（Fisher精确检验；P = 0.046）。
大多数临床评分术后显著改善。结果表明，关节镜下逆行自体骨软骨移植是一种有效的手术方法，可使大小<400 mm的胫骨平台骨软骨损伤实现足够的软骨贴合。
IV级，治疗性病例系列。
