Nielsen E Scott, McCauley Julie C, Pulido Pamela A, Bugbee William D
Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA.
Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, California, USA.
Am J Sports Med. 2017 Jun;45(7):1608-1614. doi: 10.1177/0363546517694857. Epub 2017 Apr 4.
Osteochondral allograft (OCA) transplantation is an integral part of the cartilage repair paradigm, but insufficient data are available regarding return to sport or recreational activity after the procedure.
The purpose of this study was to determine if athletic patients undergoing OCA transplantation returned to sport, assess reasons for not returning to sport, and ascertain patient and graft-related characteristics that differed between those who returned or did not return to sport. The secondary aims were to assess graft survivorship and patient-reported subjective outcome measures (pain, function, satisfaction) among athletic patients undergoing OCA transplantation.
Case series; Level of evidence, 4.
We identified 149 knees in 142 patients who participated in sport or recreational activity before a cartilage injury (45% highly competitive athletes and 55% well-trained and frequently sporting) and underwent OCA transplantation in the knee. The mean age was 31.2 years and 58.4% were male. Information on preinjury and postoperative participation in sport or recreational activity was collected. Patients not returning to sport after OCA transplantation were mailed a questionnaire to assess why. Postoperative pain, function, and satisfaction scores were obtained, and further surgery on the operative knee was documented.
At a mean follow-up of 6 years, 75.2% of knees returned to sport or recreational activity. Among those who did not return to sport, knee-related issues and lifestyle changes were cited as reasons why. Patients who did not return to sport were more likely to be female, have injured their knee in an activity other than sport, and have a larger graft size. The diagnosis and anatomic location also differed. Overall, 71% of knees reported having "very good" to "excellent" function, and 79% were able to participate in a high level of activity (moderate, strenuous, or very strenuous) postoperatively. After OCA transplantation, 25.5% of knees underwent further surgery; 14 knees (9.4% of entire cohort) were considered allograft failures. Among the 135 knees that had the graft remaining in situ, pain and function improved from preoperatively to the latest follow-up on all measures, and 91% of patients were satisfied with the results of the surgery.
OCA transplantation is a successful treatment option for athletes and highly active patients who sustain a cartilage injury to their knee. The majority of patients returned to sport or recreational activity.
骨软骨异体移植（OCA）是软骨修复模式的一个重要组成部分，但关于该手术后恢复运动或娱乐活动的数据不足。
本研究的目的是确定接受OCA移植的运动员患者是否恢复运动，评估未恢复运动的原因，并确定恢复或未恢复运动的患者之间存在差异的患者和移植物相关特征。次要目的是评估接受OCA移植的运动员患者的移植物存活率和患者报告的主观结果指标（疼痛、功能、满意度）。
病例系列；证据等级，4级。
我们确定了142例患者的149个膝关节，这些患者在软骨损伤前参加运动或娱乐活动（45%为高水平竞技运动员，55%为训练有素且经常运动者），并接受了膝关节OCA移植。平均年龄为31.2岁，58.4%为男性。收集了损伤前和术后参与运动或娱乐活动的信息。对OCA移植后未恢复运动的患者邮寄问卷以评估原因。获得术后疼痛、功能和满意度评分，并记录手术膝关节的进一步手术情况。
平均随访6年时，75.2%的膝关节恢复了运动或娱乐活动。在未恢复运动的患者中，膝关节相关问题和生活方式改变被列为原因。未恢复运动的患者更可能为女性，在非运动活动中损伤膝关节，且移植物尺寸更大。诊断和解剖位置也有所不同。总体而言，71%的膝关节报告功能为“非常好”至“优秀”，79%的患者术后能够参加高水平活动（中度、剧烈或非常剧烈）。OCA移植后，25.5%的膝关节接受了进一步手术；14个膝关节（占整个队列的9.4%）被认为是异体移植物失败。在移植物仍在位的135个膝关节中，所有测量指标的疼痛和功能从术前到最新随访均有所改善，91%的患者对手术结果满意。
OCA移植是膝关节软骨损伤的运动员和高活动量患者的一种成功治疗选择。大多数患者恢复了运动或娱乐活动。
