Shiley Center for Orthopaedic Research & Education, Scripps Clinic, La Jolla, California, USA.
Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA.
Am J Sports Med. 2018 Mar;46(4):900-907. doi: 10.1177/0363546517746106. Epub 2018 Jan 23.
Cartilage repair algorithms use lesion size to choose surgical techniques when selecting a cartilage repair procedure. The association of fresh osteochondral allograft (OCA) size with graft survivorship and subjective patient outcomes is still unknown.
To determine if lesion size (absolute or relative) affects outcomes after OCA transplantation.
Cohort study; Level of evidence, 3.
The study included 156 knees in 143 patients who underwent OCA transplantation from 1998 to 2014 for isolated femoral condyle lesions. The mean age was 29.6 ± 11.4 years, and 62.9% were male. The majority of patients (62.2%) presented for cartilage repair because of osteochondritis dissecans. The mean graft area, used as a surrogate for absolute size of the lesion, was 6.4 cm (range, 2.3-11.5 cm). The relative size of the lesion was calculated as the tibial width ratio (TWR; ratio of graft area to tibial width) and affected femoral condyle ratio (AFCR; ratio of graft area to affected femoral condyle width) using preoperative radiographs. All patients had a minimum follow-up of 2 years. Further surgical procedures were documented, and graft failure was defined as revision OCA transplantation or conversion to arthroplasty. International Knee Documentation Committee (IKDC) pain, function, and total scores were obtained. Satisfaction with OCA transplantation was assessed.
The mean follow-up among patients with grafts remaining in situ was 6.0 years (range, 1.9-16.5 years). The OCA failure rate was 5.8%. Overall survivorship of the graft was 97.2% at 5 years and 93.5% at 10 years. No difference in postoperative outcomes between groups was found in absolute or relative size. Change in IKDC scores (from preoperative to latest follow-up) was greater for knees with large lesions compared to knees with small lesions, among all measurement methods. Overall satisfaction with the results of OCA transplantation was 89.8%.
The size of the lesion, either absolute or relative, does not influence outcomes after OCA transplantation for isolated femoral condyle lesions of the knee.
软骨修复算法使用病变大小来选择当选择软骨修复程序时的手术技术。新鲜骨软骨同种异体移植物（OCA）大小与移植物存活率和主观患者结局的关系尚不清楚。
确定 OCA 移植后病变大小（绝对值或相对值）是否会影响结果。
队列研究；证据水平，3 级。
本研究纳入了 1998 年至 2014 年间因孤立的股骨髁病变接受 OCA 移植的 143 例 156 膝患者。平均年龄为 29.6±11.4 岁，62.9%为男性。大多数患者（62.2%）因剥脱性骨软骨炎而接受软骨修复。作为病变大小的替代指标，使用移植物面积的平均值为 6.4cm（范围，2.3-11.5cm）。术前 X 线片计算病变的相对大小，即胫骨宽度比（TWR；移植物面积与胫骨宽度之比）和受累股骨髁比（AFCR；移植物面积与受累股骨髁宽度之比）。所有患者的随访时间均至少为 2 年。记录进一步的手术程序，并定义 OCA 移植失败为翻修或转换为关节成形术。采用国际膝关节文献委员会（IKDC）疼痛、功能和总分进行评估。评估 OCA 移植的满意度。
在移植物仍在位的患者中，平均随访时间为 6.0 年（范围，1.9-16.5 年）。OCA 失败率为 5.8%。5 年和 10 年时，移植物总存活率分别为 97.2%和 93.5%。在绝对或相对大小方面，各组之间的术后结果无差异。与小病变相比，大病变的膝关节 IKDC 评分（从术前到最新随访）变化更大，所有测量方法均如此。OCA 移植结果的总体满意度为 89.8%。
对于膝关节孤立的股骨髁病变，OCA 移植后，病变大小（绝对值或相对值）不影响结果。
