Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA.
Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA.
Am J Sports Med. 2019 Jan;47(1):71-81. doi: 10.1177/0363546518808030. Epub 2018 Nov 27.
Mosaicplasty and fresh osteochondral allograft transplantation (OCA) are popular cartilage restoration techniques that involve the single-stage implantation of viable, mature hyaline cartilage-bone dowels into chondral lesions of the knee. Recently, there has been greater focus on what represents a clinically relevant change in outcomes reporting, and commonly applied metrics for measuring clinical significance include the minimal clinically important difference (MCID) and substantial clinical benefit (SCB).
To define the MCID and SCB after mosaicplasty or OCA for the International Knee Documentation Committee (IKDC) subjective form and Knee Outcome Survey-Activities of Daily Living (KOS-ADL) and to determine patient factors that are predictive of achieving the MCID and SCB after mosaicplasty or OCA.
Cohort study (diagnosis); Level of evidence, 3.
An institutional cartilage registry was reviewed to identify patients who underwent mosaicplasty or OCA. The decision to perform either mosaicplasty or OCA was generally based on chondral defect size. The IKDC and KOS-ADL were administered preoperatively and at a minimum of 2 years postoperatively. Patient responses to the outcome measures were aggregated, and the MCID and SCB of these outcome scores were calculated with anchor-based methods. Multivariate analysis adjusted for age and sex was performed to identify patient factors predictive of achieving the MCID and SCB.
Of the 372 eligible patients, 151 (41%) were lost to follow-up, 46 (12%) had incomplete preoperative outcome scores and 2 were treated with OCA of the tibia and therefore excluded. In total, 173 knees were analyzed (n = 173 patients; mean age, 33.0 years; 37% female). Seventy-five (43%) and 98 (57%) knees were treated with mosaicplasty and OCA, respectively. The mean ± SD MCIDs for the IKDC and KOS-ADL were 17 ± 3.9 and 10 ± 3.7, respectively. The SCBs for the IKDC and KOS-ADL were 30 ± 6.9 and 17 ± 3.9, respectively. Univariate analysis demonstrated no association between procedure (mosaicplasty or OCA) and likelihood of achieving the MCID or SCB. In the multivariate analysis, lower preoperative IKDC and KOS-ADL scores, higher preoperative Marx Activity Rating Scale scores, lower preoperative 36-Item Short Form Health Survey pain scores, and a history of ≤1 prior ipsilateral knee surgical procedure were predictive of achieving the MCID and/or SCB.
These values can be used to define a clinically meaningful improvement for future outcome studies. For surgeons considering mosaicplasty or OCA for their patients, these results can help guide clinical decision making and manage patient expectations before surgery.
马赛克plasty 和新鲜骨软骨同种异体移植（OCA）是流行的软骨修复技术，涉及将有活力的成熟透明软骨 - 骨栓单次植入膝关节软骨病变。最近，人们更加关注在结果报告中代表临床相关变化的内容，并且通常应用于测量临床意义的指标包括最小临床重要差异（MCID）和实质性临床获益（SCB）。
定义马赛克plasty 或 OCA 后国际膝关节文献委员会（IKDC）主观表格和膝关节结果调查 - 日常生活活动（KOS-ADL）的 MCID 和 SCB，并确定预测马赛克plasty 或 OCA 后达到 MCID 和 SCB 的患者因素。
队列研究（诊断）; 证据水平，3 级。
对机构软骨登记处进行了回顾，以确定接受马赛克plasty 或 OCA 的患者。进行马赛克plasty 或 OCA 的决定通常基于软骨缺损的大小。在术前和至少 2 年后进行 IKDC 和 KOS-ADL 评估。汇总患者对结果测量的反应，并使用基于锚的方法计算这些结果得分的 MCID 和 SCB。进行多变量分析以调整年龄和性别，以确定预测达到 MCID 和 SCB 的患者因素。
在 372 名符合条件的患者中，有 151 名（41%）失访，46 名（12%）术前结局评分不完整，2 名患者接受胫骨 OCA 治疗，因此被排除在外。总共分析了 173 个膝关节（n = 173 个膝关节; 平均年龄 33.0 岁; 37%女性）。75 个（43%）和 98 个（57%）膝关节分别接受了马赛克plasty 和 OCA 治疗。IKDC 和 KOS-ADL 的平均±SD MCID 分别为 17±3.9 和 10±3.7。IKDC 和 KOS-ADL 的 SCB 分别为 30±6.9 和 17±3.9。单变量分析表明，手术方式（马赛克plasty 或 OCA）与达到 MCID 或 SCB 的可能性之间没有关联。在多变量分析中，较低的术前 IKDC 和 KOS-ADL 评分，较高的术前 Marx 活动评分量表评分，较低的术前 36-Item 短期健康调查疼痛评分，以及同侧膝关节手术史≤1 次，与达到 MCID 和/或 SCB 相关。
这些值可用于为未来的结果研究定义具有临床意义的改善。对于考虑为患者进行马赛克plasty 或 OCA 的外科医生，这些结果可以帮助指导手术前的临床决策和管理患者的期望。
