Schmidt Kenneth J, Tírico Luís E, McCauley Julie C, Bugbee William D
Banner Good Samaritan Medical Center, Phoenix, Arizona, USA.
Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, California, USA.
Am J Sports Med. 2017 Aug;45(10):2260-2266. doi: 10.1177/0363546517704846. Epub 2017 May 22.
Regulatory concerns and the popularity of fresh osteochondral allograft (OCA) transplantation have led to a need for prolonged viable storage of osteochondral grafts. Tissue culture media allow a longer storage time but lead to chondrocyte death within the tissue. The long-term clinical consequence of prolonged storage is unknown.
Patients transplanted with OCAs with a shorter storage time would have lower failure rates and better clinical outcomes than those transplanted with OCAs with prolonged storage.
Cohort study; Level of evidence, 3.
A matched-pair study was performed of 75 patients who received early release grafts (mean storage, 6.3 days [range, 1-14 days]) between 1997 and 2002, matched 1:1 by age, diagnosis, and graft size, with 75 patients who received late release grafts (mean storage time, 20.0 days [range, 16-28 days]) from 2002 to 2008. The mean age was 33.5 years, and the median graft size was 6.3 cm. All patients had a minimum 2-year follow-up. Evaluations included pain, satisfaction, function, failures, and reoperations. Outcome measures included the modified Merle d'Aubigné-Postel (18-point) scale, International Knee Documentation Committee (IKDC) form, and Knee Society function (KS-F) scale. Clinical failure was defined as revision OCA transplantation or conversion to arthroplasty.
Among patients with grafts remaining in situ, the mean follow-up was 11.9 years (range, 2.0-16.8 years) and 7.8 years (range, 2.3-11.1 years) for the early and late release groups, respectively. OCA failure occurred in 25.3% (19/75) of patients in the early release group and 12.0% (9/75) of patients in the late release group ( P = .036). The median time to failure was 3.5 years (range, 1.7-13.8 years) and 2.7 years (range, 0.3-11.1 years) for the early and late release groups, respectively. The 5-year survivorship of OCAs was 85% for the early release group and 90% for the late release group ( P = .321). No differences in postoperative pain and function were noted between the groups. Ninety-one percent of the early release group and 93% of the late release group reported satisfaction with OCA results.
The transplantation of OCA tissue with prolonged storage is safe and effective for large osteochondral lesions of the knee and has similar clinical outcomes and satisfaction to the transplantation of early release grafts.
监管方面的关注以及新鲜骨软骨异体移植（OCA）的普及，使得延长骨软骨移植物的存活储存成为必要。组织培养基虽能延长储存时间，但会导致组织内软骨细胞死亡。长期储存的长期临床后果尚不清楚。
与移植储存时间延长的OCA患者相比，移植储存时间较短的OCA患者失败率更低，临床结果更好。
队列研究；证据等级，3级。
对1997年至2002年间接受早期释放移植物（平均储存时间6.3天[范围1 - 14天]）的75例患者进行配对研究，按年龄、诊断和移植物大小1:1匹配2002年至2008年间接受晚期释放移植物（平均储存时间20.0天[范围16 - 28天]）的75例患者。平均年龄为33.5岁，移植物中位数大小为6.3厘米。所有患者至少随访2年。评估包括疼痛、满意度、功能、失败情况和再次手术。结果指标包括改良的Merle d'Aubigné - Postel（18分）量表、国际膝关节文献委员会（IKDC）表格和膝关节协会功能（KS - F）量表。临床失败定义为翻修OCA移植或转换为关节成形术。
在移植物原位留存的患者中，早期和晚期释放组的平均随访时间分别为11.9年（范围2.0 - 16.8年）和7.8年（范围2.3 - 11.1年）。早期释放组25.3%（19/75）的患者发生OCA失败，晚期释放组为12.0%（9/75）的患者（P = 0.036）。早期和晚期释放组的失败中位时间分别为3.5年（范围1.7 - 13.8年）和2.7年（范围0.3 - 11.1年）。OCA的5年生存率在早期释放组为85%，晚期释放组为90%（P = 0.321）。两组间术后疼痛和功能无差异。早期释放组91%和晚期释放组93%的患者对OCA结果表示满意。
储存时间延长的OCA组织移植对于膝关节大的骨软骨损伤是安全有效的，并且与早期释放移植物移植具有相似的临床结果和满意度。
