Sports Medicine Center, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.
Cartilage Repair Center and Center for Regenerative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.; Universidade Federal de São Paulo, São Paulo, Brazil.
Arthroscopy. 2019 Aug;35(8):2436-2444. doi: 10.1016/j.arthro.2019.03.033.
To accurately evaluate the effects of bone marrow aspirate (BMA) augmentation on osteochondral allograft (OCA) integration on early postoperative magnetic resonance imaging (MRI) using the comprehensive Osteochondral Allograft MRI Scoring System (OCAMRISS).
This imaging study compared patients who underwent OCA transplantation with and without BMA augmentation for the treatment of focal osteochondral defects in the knee performed by a single surgeon between July 2013 and July 2017. Patients were excluded if they underwent implantation of premade plugs, had an overlapping OCA configuration ("snowman" technique), or did not undergo MRI at 6 months postoperatively. Patients were matched by lesion location, lesion size, age, and body mass index, as well as whether they underwent previous surgical procedures. Data were analyzed using descriptive statistics, Spearman correlation, the independent t test, the Mann-Whitney U test, and the χ test.
A total of 58 patients (29 per group) were included in this study, with an average age of 36.4 ± 10.1 years and mean body mass index of 28.6 ± 5.1. The mean size of the analyzed OCA plugs was 3.3 ± 1 cm. At an average imaging follow-up of 5.6 ± 1 months, 86.2% of the grafts had achieved osseous integration at the graft-host junction and 75.9% did not show any cystic changes in the subchondral bone. No difference in any OCAMRISS subscale was seen comparing OCAs with and without BMA augmentation (P > .05). Specifically, osseous integration and subchondral cyst formation were comparable between groups (P = .128 and P = .539, respectively).
OCAs showed excellent osseous integration at the graft-host junction on 6-month postoperative MRI. The treatment of OCAs with autogenous BMA did not result in superior imaging outcomes when analyzed using the OCAMRISS.
Level III, case-control study.
使用综合的骨软骨异体移植物 MRI 评分系统（OCAMRISS），准确评估骨髓抽吸（BMA）增强对异体骨软骨移植物（OCA）整合的早期术后磁共振成像（MRI）的影响。
本影像学研究比较了 2013 年 7 月至 2017 年 7 月间由同一位外科医生进行的 OCA 移植治疗膝关节局灶性骨软骨缺损的患者中，接受和未接受 BMA 增强的患者。如果患者接受了预制插件植入、OCA 配置重叠（“雪人”技术）或术后 6 个月未行 MRI，则将其排除在外。通过病变部位、病变大小、年龄和体重指数以及是否进行过先前的手术来对患者进行匹配。使用描述性统计、Spearman 相关、独立 t 检验、Mann-Whitney U 检验和 χ 检验对数据进行分析。
共有 58 名患者（每组 29 名）纳入本研究，平均年龄为 36.4 ± 10.1 岁，平均体重指数为 28.6 ± 5.1。分析的 OCA 插件的平均大小为 3.3 ± 1 cm。在平均影像学随访 5.6 ± 1 个月时，86.2%的移植物在移植物-宿主交界处实现了骨性整合，75.9%的移植物在软骨下骨中没有出现任何囊性改变。在有无 BMA 增强的 OCA 之间，OCAMRISS 各亚量表的差异均无统计学意义（P >.05）。具体而言，两组之间的骨性整合和软骨下囊形成相似（P =.128 和 P =.539）。
OCA 在术后 6 个月的 MRI 上显示出在移植物-宿主交界处极好的骨性整合。使用 OCAMRISS 分析时，自体 BMA 治疗 OCA 并未导致影像学结果更优。
III 级，病例对照研究。
