Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A..
Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A.
Arthroscopy. 2019 Jun;35(6):1880-1889. doi: 10.1016/j.arthro.2018.11.064. Epub 2019 Apr 30.
To report current data on return-to-sport rates and sports-specific patient-reported outcomes after osteochondral allograft (OCA) transplantation for cartilage defects of the knee.
We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines that included studies from 1975 to 2018 with a minimum 2-year mean follow-up that reported return-to-sport rates or sports-specific patient-reported outcomes. Outcomes, reoperations, and complications were provided in table format, and a subjective analysis was performed.
This review included 13 studies with 772 patients who underwent OCA transplantation at a mean of 24 to 91 months' follow-up. The return-to-sport rate ranged from 75% to 82%. For patient-reported outcomes, the Knee Injury and Osteoarthritis Score Sport increased in 4 studies, the Tegner activity scale score increased in 3 studies but decreased in 1, and the Marx activity scale score increased in 1 study but decreased in 2. Studies reporting improvements in the Cincinnati Knee Score and Knee Injury and Osteoarthritis Score Sport reached the minimal clinically important difference. The reoperation rate was high (ranging from 34% to 53% in more than half of studies), with reoperations primarily performed for loose body removal or debridement.
This systematic review of 13 studies suggests that OCA transplantation for cartilage defects allows most athletes to return to sport (range, 75%-82%). Most studies reported improvements in sports-specific patient-reported outcomes at follow-up and reached the minimal clinically important difference. However, the reoperation rate was high in several studies, with a large percentage of patients requiring loose body removal or debridement. The long-term survival of the allografts is largely unknown, but this study suggests OCA transplantation consistently improves function in athletes with chondral injuries.
Level IV, systematic review of Level III and IV studies.
报告软骨缺损行异体骨软骨移植（OCA）后患者重返运动的比例及运动专项患者报告结局的最新数据。
我们根据系统评价和荟萃分析（PRISMA）指南进行了系统回顾，纳入了 1975 年至 2018 年的研究，这些研究的平均随访时间至少为 2 年，并报告了重返运动的比例或运动专项患者报告结局。结果以表格形式呈现，同时进行了主观分析。
本综述纳入了 13 项研究，共 772 例患者，平均随访 24 至 91 个月后接受 OCA 移植。重返运动的比例为 75%至 82%。在患者报告的结局中，有 4 项研究的膝关节损伤和骨关节炎评分（Knee Injury and Osteoarthritis Score Sport）增加，3 项研究的 Tegner 活动量表评分增加，1 项研究减少，1 项研究的 Marx 活动量表评分增加，2 项研究减少。报告膝关节 Cincinnati 评分和膝关节损伤和骨关节炎评分（Knee Injury and Osteoarthritis Score Sport）改善达到最小临床重要差异的研究。再次手术率较高（超过半数研究中为 34%至 53%），再次手术主要是为了清除游离体或清创。
本系统回顾纳入的 13 项研究表明，异体骨软骨移植治疗软骨缺损可使大多数运动员重返运动（75%至 82%）。大多数研究报告了随访时运动专项患者报告结局的改善，并达到了最小临床重要差异。然而，几项研究的再次手术率较高，大部分患者需要清除游离体或清创。异体移植物的长期存活率尚不清楚，但本研究表明，异体骨软骨移植可持续改善有软骨损伤运动员的功能。
IV 级，对 III 级和 IV 级研究的系统评价。
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