Tírico Luís E P, Early Samuel A, McCauley Julie C, Bugbee William D
Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.
University of California San Diego Medical School, La Jolla, California, USA.
Orthop J Sports Med. 2017 Oct 3;5(10):2325967117730540. doi: 10.1177/2325967117730540. eCollection 2017 Oct.
Spontaneous osteonecrosis of the knee (SONK) is a clinical entity identified by acute knee pain usually associated with joint effusion, with radiographic findings of a radiolucent defect on the weightbearing area of the femoral condyle. Conservative treatment is initially undertaken; however, surgical procedures are often necessary. Historically, surgical options have included core decompression, cartilage repair, high tibial osteotomy, or joint arthroplasty. Few studies in the literature have reported the use of fresh osteochondral allograft (OCA) for the treatment of SONK lesions.
OCA transplantation is an effective treatment for SONK lesions on the medial femoral condyle.
Case series; Level of evidence, 4.
A case series was analyzed of 7 patients treated with OCA for large SONK lesions of the medial femoral condyle with a minimum 4-year follow-up. All patients experienced failure of at least 6 months of conservative treatment and declined arthroplasty as the form of definitive treatment for medial femoral condyle lesion. All patients underwent OCA of the medial femoral condyle. Mean lesion size was 4.6 cm (range, 3.24-6.25 cm), with a mean condylar width of 41.7 mm (range, 35.4-48.6 mm), resulting in a median proportion (lesion size/condylar width) of 56.8% (range, 32.7%-62.6%). The median surface allograft area was 5.1 cm (range, 3.2-6.3 cm).
The median follow-up was 7.1 years (range, 4.5-14.1 years). No patient had additional surgery following OCA transplant; the allograft failure rate was 0%. Subjective outcome scores from the International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, and modified Merle d'Aubigné-Postel scale improved from preoperative assessment to the latest follow-up. All patients were extremely satisfied with the results of the OCA transplant.
Fresh OCA transplantation demonstrated excellent efficacy, durability, and satisfaction in this group of patients with isolated stage 2 and 3 SONK lesions who had experienced failure of conservative treatment. Fresh osteochondral allografts are an attractive method for surgical management of selected patients with spontaneous osteonecrosis of the knee.
膝关节自发性骨坏死（SONK）是一种临床病症，其特征为急性膝关节疼痛，通常伴有关节积液，影像学表现为股骨髁负重区的透亮缺损。最初采用保守治疗；然而，手术治疗往往是必要的。从历史上看，手术选择包括髓芯减压、软骨修复、高位胫骨截骨术或关节置换术。文献中很少有研究报道使用新鲜骨软骨异体移植（OCA）治疗SONK病变。
OCA移植是治疗股骨内侧髁SONK病变的有效方法。
病例系列；证据等级，4级。
分析了7例接受OCA治疗股骨内侧髁大型SONK病变患者的病例系列，随访时间至少4年。所有患者至少6个月的保守治疗均失败，且拒绝将关节置换术作为股骨内侧髁病变的最终治疗方式。所有患者均接受了股骨内侧髁的OCA治疗。平均病变大小为4.6厘米（范围3.24 - 6.25厘米），平均髁宽度为41.7毫米（范围35.4 - 48.6毫米），病变大小与髁宽度的中位数比例为56.8%（范围32.7% - 62.6%）。异体移植表面的中位数面积为5.1厘米（范围3.2 - 6.3厘米）。
中位随访时间为7.1年（范围4.5 - 14.1年）。OCA移植后没有患者进行额外手术；异体移植失败率为0%。国际膝关节文献委员会、膝关节损伤和骨关节炎疗效评分以及改良的Merle d'Aubigné - Postel量表的主观结果评分从术前评估到最新随访均有所改善。所有患者对OCA移植的结果极为满意。
对于这组保守治疗失败的孤立性2期和3期SONK病变患者，新鲜OCA移植显示出优异的疗效、耐用性和满意度。新鲜骨软骨异体移植是治疗部分膝关节自发性骨坏死患者的一种有吸引力的手术方法。
