Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Am J Sports Med. 2018 Oct;46(12):2884-2893. doi: 10.1177/0363546518793405. Epub 2018 Sep 4.
There is a paucity of literature regarding the outcomes of adjacent-plug osteochondral allograft transplantation (OCA) for irregular or ovoid lesions and multifocal OCA for multicompartmental, focal lesions.
To quantify the survival of multiplug OCA for larger, high-grade chondral lesions with the "snowman" technique versus that of multicompartmental or bipolar OCA.
Case series; Level of evidence, 4.
All patients who underwent primary, multiplug OCA for large unicondylar, multicompartmental (eg, bipolar patellofemoral and condylar, bicondylar), or bipolar chondral defects (ie, patellofemoral) with a minimum 2-year follow-up by a single surgeon from April 1, 2003, to April 1, 2015, were analyzed. Failure was defined as revision OCA, conversion to arthroplasty, or gross appearance of graft degeneration on second-look arthroscopic surgery.
Twenty-six patients (28 knees) were identified, with 22 patients (24 knees; 50% female; mean age, 31.9 ± 9.1 years) having at least 2-year clinical follow-up (85.7%). Nine patients (9 knees) underwent isolated, condylar OCA with the snowman technique and had a mean follow-up of 7.4 ± 3.6 years (range, 1.38-11.14 years), while 13 additional patients (15 knees) underwent multifocal OCA and had a mean follow-up of 6.4 ± 3.9 years (range, 2.07-12.38 years). Reoperations were common, with 44.4% (n = 4) of the snowman group and 20.0% (n = 3) of the multifocal group undergoing at least 1 reoperation. There were 3 failures (33.3%) in the snowman group at a mean 7.7 ± 5.5 years and 1 failure (6.7%) in the multifocal group at 4.5 ± 0.0 years, with all undergoing secondary total knee arthroplasty. Patients who underwent snowman OCA demonstrated significant postoperative improvement in the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscore and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) overall score ( P < .05 for both). Patients who underwent multifocal OCA demonstrated significant improvement in the International Knee Documentation Committee score; KOOS symptoms, activities of daily living, sport, and quality of life subscores; WOMAC stiffness, function, and overall subscores; and 12-Item Short Form Health Survey physical component summary score ( P < .05 for all).
Patients who underwent unicondylar, multiplug OCA using the snowman technique demonstrated inferior clinical outcomes, higher reoperation rates, and greater failure rates than those who underwent isolated single-graft transplantation. By contrast, multifocal OCA may be a viable knee preservation technique for young, active patients with multicompartmental chondral disease, leading to improved clinical outcomes and low reoperation and failure rates at midterm follow-up.
关于不规则或卵形病变的相邻插栓骨软骨同种异体移植（OCA）和多灶性 OCA 治疗多间室、局灶性病变的结果的文献很少。
用“雪人”技术量化较大的高级软骨病变的多插栓 OCA 的存活率，与多间室或双极 OCA 相比。
病例系列；证据水平，4 级。
所有患者均接受了初次治疗，由一位外科医生在 2003 年 4 月 1 日至 2015 年 4 月 1 日期间，对大小单一髁、多间室（如双极髌股和髁间、双髁）或双极（即髌股）的大、多间室性或双极软骨缺损进行了多插栓 OCA，至少有 2 年的随访。失败定义为翻修 OCA、转换为关节成形术或在第二次关节镜检查时发现移植物退变的大体外观。
确定了 26 例患者（28 个膝关节），其中 22 例患者（24 个膝关节；50%为女性；平均年龄 31.9±9.1 岁）有至少 2 年的临床随访（85.7%）。9 例患者（9 个膝关节）接受了孤立的、髁间的“雪人”技术 OCA，平均随访 7.4±3.6 年（范围 1.38-11.14 年），而另外 13 例患者（15 个膝关节）接受了多灶性 OCA，平均随访 6.4±3.9 年（范围 2.07-12.38 年）。再手术很常见，“雪人”组有 44.4%（n=4），多灶组有 20.0%（n=3）至少进行了 1 次再手术。“雪人”组中有 3 例（33.3%）失败，平均 7.7±5.5 年；多灶组中有 1 例（6.7%）失败，平均 4.5±0.0 年，均行二期全膝关节置换术。行“雪人”OCA 的患者术后膝关节损伤和骨关节炎结果评分（KOOS）疼痛子评分和西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）总评分显著改善（均 P<.05）。行多灶 OCA 的患者国际膝关节文献委员会评分、KOOS 症状、日常生活活动、运动和生活质量子评分、WOMAC 僵硬、功能和总子评分以及 12 项简明健康调查身体成分综合评分显著改善（均 P<.05）。
与单独单移植物移植相比，接受单髁、多栓 OCA 采用“雪人”技术的患者临床结果较差，再手术率和失败率较高。相比之下，多灶性 OCA 可能是治疗多间室软骨病的年轻、活跃患者的一种可行的膝关节保留技术，可改善中期随访的临床结果，并降低再手术和失败率。
