Magna Graecia University, Catanzaro, Italy.
Steadman Philippon Research Institute, Vail, Colorado, USA.
Am J Sports Med. 2018 Dec;46(14):3541-3549. doi: 10.1177/0363546517732531. Epub 2017 Oct 17.
Cartilage lesions are a significant cause of morbidity and impaired knee function; however, cartilage repair procedures have failed to reproduce native cartilage to date. Thus, osteochondral allograft (OCA) transplantation represents a 1-step procedure to repair large chondral defects without the donor site morbidity of osteochondral autograft transplantation.
To perform a systematic review of clinical outcomes and failure rates after OCA transplantation in the knee at a minimum mean 2 years' follow-up.
Systematic review; Level of evidence, 4.
A systematic review of the literature regarding the existing evidence for clinical outcomes and failure rates of OCA transplantation in the knee joint was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE from studies published between 1980 and 2017. Inclusion criteria were as follows: clinical outcomes and failure rates of OCAs for the treatment of chondral defects in the knee joint, English language, mean follow-up of 2 years and minimum follow-up of 18 months, minimum study size of 20 patients, and human studies. The methodological quality of each study was assessed using a modified version of the Coleman methodology score.
The systematic search identified 19 studies with a total of 1036 patients. The mean 5-year survival rate across the studies included in this review was 86.7% (range, 64.1%-100.0%), while the mean 10-year survival rate was 78.7% (range, 39.0%-93.0%). The mean survival rate was 72.8% at 15 years (range, 55.8%-84.0%) and 67.5% at 20 years (range, 66.0%-69.0%). The weighted mean patient age was 31.5 years (range, 10-82 years), and the weighted mean follow-up was 8.7 years (range, 2-32 years). The following outcome measures showed significant improvement from preoperatively to postoperatively: d'Aubigné-Postel, International Knee Documentation Committee, Knee Society function, and Lysholm scores. The weighted mean reoperation rate was 30.2% (range, 0%-63%). The weighted mean failure rate was 18.2% (range, 0%-31%). Of note, revision cases, patellar lesions, and bipolar lesions demonstrated worse survival rates.
Improved patient-reported outcomes can be expected after OCA transplantation, with a survival rate of 78.7% at 10 years. Revision cases, patellar lesions, and bipolar lesions were associated with worse survival rates; therefore, utilization of the most appropriate index cartilage restoration procedure and proper patient selection are key to improving results.
软骨损伤是导致膝关节发病率和功能障碍的重要原因；然而，到目前为止，软骨修复手术未能复制出原生软骨。因此，同种异体骨软骨移植（OCA）代表了一种一步修复大的软骨缺损的方法，而不会产生骨软骨自体移植的供区发病率。
对至少 2 年随访的膝关节 OCA 移植的临床结果和失败率进行系统评价。
系统评价；证据水平，4。
使用 Cochrane 系统评价数据库、Cochrane 对照试验中心注册库、PubMed 和 MEDLINE 对 1980 年至 2017 年期间发表的有关膝关节 OCA 移植临床结果和失败率的现有证据进行系统评价。纳入标准如下：用于治疗膝关节软骨缺损的 OCAs 的临床结果和失败率，英语语言，至少 2 年的平均随访时间和至少 18 个月的随访时间，最低研究样本量为 20 例，以及人类研究。使用改良的 Coleman 方法评分评估每个研究的方法学质量。
系统搜索确定了 19 项研究，共 1036 例患者。本综述纳入研究的 5 年总体生存率为 86.7%（范围，64.1%-100.0%），10 年生存率为 78.7%（范围，39.0%-93.0%）。15 年的平均生存率为 72.8%（范围，55.8%-84.0%），20 年的平均生存率为 67.5%（范围，66.0%-69.0%）。加权平均患者年龄为 31.5 岁（范围，10-82 岁），加权平均随访时间为 8.7 年（范围，2-32 年）。以下结果测量指标从术前到术后均有显著改善：d'Aubigné-Postel、国际膝关节文献委员会、膝关节学会功能和 Lysholm 评分。加权平均再次手术率为 30.2%（范围，0%-63%）。加权平均失败率为 18.2%（范围，0%-31%）。需要注意的是，翻修病例、髌骨病变和双极病变的生存率较差。
OCA 移植后可预期患者报告结果得到改善，10 年生存率为 78.7%。翻修病例、髌骨病变和双极病变与生存率较差相关；因此，选择最合适的指数软骨修复程序和适当的患者选择是提高疗效的关键。
