Hospital for Special Surgery, New York, NY.
Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Bone Joint Surg Am. 2018 Nov 7;100(21):1838-1844. doi: 10.2106/JBJS.17.01508.
There is a paucity of clinical studies that compare the efficacy of autograft and allograft in osteochondral transplantation for treatment of osteochondral lesions of the talus (OLT). The purpose of the present study was to compare the clinical and radiographic outcomes following osteochondral transplantation with autograft or allograft for OLT.
A retrospective analysis comparing patients treated with autograft or allograft for OLT was performed. Clinical outcomes were evaluated with use of the Foot and Ankle Outcome Score (FAOS) and the Short Form-12 (SF-12) score. Magnetic resonance imaging (MRI) was evaluated with use of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. The rates of cyst occurrence, graft degradation, graft failure, and revision surgeries were also evaluated.
Twenty-five nonrandomized patients with autograft and 16 with allograft were included, with a mean follow-up of 26 months in the autograft group and 22 months in the allograft group. There were no significant differences among all demographic variables between the autograft and allograft groups. The mean postoperative FAOS was significantly higher in the autograft group (81.9; 95% confidence interval [CI]: 78.6 to 85.2) than in the allograft group (70.1; 95% CI: 63.7 to 76.5; p = 0.006). Similarly, the mean postoperative SF-12 scores were significantly higher in the autograft group (74.7; 95% CI: 71.0 to 78.4) than in the allograft group (66.1; 95% CI: 61.2 to 71.0; p = 0.021). MOCART scores were significantly better in the autograft group (87.1) than in the allograft group (75.5; p = 0.005). The rate of chondral wear on MRI was higher in the allograft group (53%) than in the autograft group (4%; p < 0.001). Cyst formation in the graft itself was more likely to occur in the allograft group (47%) than in the autograft group (8%; p = 0.017). The rate of secondary procedures for the graft was higher in the allograft group (25%) than in the autograft group (0%; p = 0.009).
In this small nonrandomized cohort study, the procedures performed with use of an autograft provided better clinical and MRI outcomes than the allograft procedures. The rate of chondral wear on MRI was higher with allograft than with autograft, and allograft-treated patients had a higher rate of clinical failure.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
目前鲜有临床研究比较自体移植物和同种异体移植物在治疗距骨骨软骨病变（OLT）中的疗效。本研究旨在比较自体移植物和同种异体移植物治疗 OLT 的临床和影像学结果。
对接受自体或同种异体 OLT 的患者进行回顾性分析。采用足踝结局评分（FAOS）和简明健康状况调查问卷 12 项（SF-12）评分评估临床结果。采用磁共振软骨修复组织观察评分（MOCART）评估磁共振成像（MRI）。还评估了囊肿发生、移植物降解、移植物失败和翻修手术的发生率。
纳入 25 例接受自体移植物和 16 例接受同种异体移植物的非随机患者，自体移植物组的平均随访时间为 26 个月，同种异体移植物组为 22 个月。自体移植物组和同种异体移植物组在所有人口统计学变量方面均无显著差异。自体移植物组的术后 FAOS 平均得分（81.9；95%置信区间[CI]：78.6 至 85.2）显著高于同种异体移植物组（70.1；95%CI：63.7 至 76.5；p=0.006）。同样，自体移植物组的术后 SF-12 评分（74.7；95%CI：71.0 至 78.4）也显著高于同种异体移植物组（66.1；95%CI：61.2 至 71.0；p=0.021）。自体移植物组的 MOCART 评分（87.1）显著高于同种异体移植物组（75.5；p=0.005）。同种异体移植物组的 MRI 上软骨磨损率（53%）高于自体移植物组（4%；p<0.001）。同种异体移植物组（47%）的移植物内囊肿形成发生率高于自体移植物组（8%；p=0.017）。同种异体移植物组的二次移植物手术率（25%）高于自体移植物组（0%；p=0.009）。
在这项小型非随机队列研究中，自体移植物手术的临床和 MRI 结果优于同种异体移植物手术。同种异体移植物的 MRI 上软骨磨损率高于自体移植物，同种异体移植物治疗的患者临床失败率更高。
治疗性 III 级。有关证据水平的完整描述，请参见作者说明。
