Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Arthroscopy. 2018 Apr;34(4):1105-1112. doi: 10.1016/j.arthro.2017.10.043. Epub 2018 Jan 2.
To report clinical outcomes of osteochondral allograft transplantation (OCA) for skeletally mature patients with osteochondritis dissecans (OCD) lesions of the knee in whom prior surgical intervention has failed, and to describe return-to-sport (RTS) rates and any predictive demographic or preoperative variables associated with a higher likelihood to RTS.
Patients who underwent OCA by a single surgeon (B.J.C.) between October 1, 2002, and November 30, 2014, for a diagnosis of OCD with a minimum of 2 years' follow-up were included. Demographic, surgical history, operative, and postoperative data points including RTS were analyzed for all patients collectively, with subanalysis to identify any demographic and operative variables associated with the ability to RTS. Failure was defined as revision OCA, gross appearance of graft failure on second-look arthroscopy, or conversion to arthroplasty.
We identified 41 consecutive patients (43 knees), with 37 patients (39 knees, comprising 26 male and 13 female knees) available for clinical follow-up at an average of 7.29 ± 3.30 years. There was significant improvement (P < .05) in all patient-reported outcome scores, with the exception of the Short Form 12 mental subscale (P = .910). Most patients (81.6%) reported being either mostly satisfied or completely satisfied at final follow-up. Of patients self-identifying as athletes preoperatively (n = 22), 18 (81.8%) achieved RTS at an average of 14.0 ± 8.7 months. Athletes with failure to RTS had a significantly greater body mass index (RTS, 24.68 ± 3.67; no RTS, 27.82 ± 0.69; P = .005). Subsequent surgery was performed in 14 patients (35.9%), and primary OCA failed in 2 patients at an average of 6.2 ± 3.8 years.
OCA is a successful secondary surgical treatment for OCD of the knee in skeletally mature patients and leads to clinically meaningful improvements in patient-reported outcome scores and high patient satisfaction and RTS rates in low-level athletes at an average of 7.29 years' follow-up. Athletes with failure to RTS were found to have a significantly higher body mass index. Although reoperation may be common after OCA (35.9%), the failure rate is low (5.1%) in this series.
Level IV, case series.
报告在先前手术干预失败的患有骺软骨骨软骨病（OCD）病变的骨骼成熟患者中，进行同种异体骨软骨移植（OCA）的临床结果，并描述重返运动（RTS）的比率以及与更高 RTS 可能性相关的任何预测性人口统计学或术前变量。
纳入了 2002 年 10 月 1 日至 2014 年 11 月 30 日期间由一名外科医生（BJC）进行 OCA 的患者，这些患者均经诊断患有 OCD，随访时间至少 2 年。对所有患者的人口统计学、手术史、手术和术后数据点进行了分析，包括 RTS，对确定与 RTS 能力相关的任何人口统计学和手术变量进行了亚分析。失败的定义是翻修 OCA、二次关节镜检查中移植物外观失败或转换为关节置换术。
我们共确定了 41 例连续患者（43 个膝关节），其中 37 例患者（39 个膝关节，包括 26 个男性和 13 个女性膝关节）在平均 7.29±3.30 年的时间内接受了临床随访。除了短格式 12 项精神子量表（P=.910）外，所有患者报告的结果均有显著改善（P<.05）。大多数患者（81.6%）在最终随访时报告为非常满意或完全满意。术前自我认定为运动员的患者（n=22）中，18 例（81.8%）在平均 14.0±8.7 个月后实现了 RTS。未能实现 RTS 的运动员的 BMI 显著更高（RTS：24.68±3.67；非 RTS：27.82±0.69；P=.005）。14 例患者（35.9%）接受了后续手术，2 例患者在平均 6.2±3.8 年后原发性 OCA 失败。
OCA 是骨骼成熟患者膝关节骺软骨骨软骨病的一种成功的二次手术治疗方法，可导致患者报告的结果在临床上有显著改善，并在平均 7.29 年的随访中使低水平运动员的患者满意度和 RTS 率非常高。未能实现 RTS 的运动员的 BMI 显著更高。尽管 OCA 后可能需要进行再次手术（35.9%），但本系列的失败率较低（5.1%）。
IV 级，病例系列研究。
