Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.
Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA.
Am J Sports Med. 2020 May;48(6):1356-1364. doi: 10.1177/0363546520907101. Epub 2020 Mar 5.
Articular cartilage lesions in the knee remain a challenging clinical problem.
A novel graft preservation method combined with surgical technique and patient management improvements would lead to consistently successful outcomes after osteochondral allograft (OCA) transplantation.
Cohort study; Level of evidence, 3.
With institutional review board approval and informed consent, patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. Patients were included when ≥1-year follow-up data were available, including complications and reoperations, patient-reported outcome measures (PROMs), compliance with rehabilitation, revisions, and failures.
For patients meeting inclusion criteria (N = 194), mean ± SD age was 37.9 ± 12.2 years and mean BMI was 28.9 ± 5; 38% received unipolar transplants (44% multisurface) and 62% received bipolar transplants. OCAs were preserved by standard tissue bank methods (standard preservation [SP]; 29%) or the novel method (Missouri Osteochondral Preservation System [MOPS]; 71%). Initial success rates were 79% for all cases combined, 60% for SP, and 84% for MOPS. MOPS cases were significantly ( = .028) more likely to be associated with successful outcomes when compared with SP cases. PROMs improved significantly ( < .05) for all cohorts through 3 to 4 years of follow-up. Revisions were performed in 19 cases (10%). MOPS grafts were associated with a significantly ( = .0014) lower revision rate (5%) than SP grafts (21%). Failures occurred in 26 patients (13%), with all undergoing total knee arthroplasty. Bipolar cases were significantly ( = .008) more likely to be associated with failure. MOPS grafts were associated with a significantly ( = .048) lower failure rate (11%) than were SP grafts (19%). Noncompliance with the prescribed rehabilitation protocol was significantly ( = .00008) more likely to be associated with failure.
Prospective data for 194 cases revealed that OCA transplantation for unipolar, multisurface, and bipolar cartilage restoration can be associated with consistently successful outcomes. The 5% revision rate, 11% failure rate, 82%-94% survival probability estimates, and continually improving PROMs through postoperative 3 to 4 years underscore major advances in outcomes as compared with previous reports. These encouraging results were realized with the use of a novel graft preservation method; autogenous bone marrow concentrate pretreatment of donor bone; advancements in graft cutting, implantation, and stabilization techniques; and procedure-specific rehabilitation protocols.
膝关节的关节软骨损伤仍然是一个具有挑战性的临床问题。
一种新的移植物保存方法结合手术技术和患者管理的改进，将导致骨软骨同种异体移植（OCA）后始终获得成功的结果。
队列研究；证据水平，3 级。
经机构审查委员会批准和知情同意，前瞻性地将患者纳入 OCA 移植后随访结果的登记处。当有≥ 1 年的随访数据时，包括并发症和再次手术、患者报告的结果测量（PROMs）、康复依从性、翻修和失败，患者被纳入。
对于符合纳入标准的患者（N = 194），平均年龄 ± 标准差为 37.9 ± 12.2 岁，平均 BMI 为 28.9 ± 5；38%接受单极移植（44%多表面），62%接受双极移植。OCA 通过标准组织库方法（标准保存[SP]；29%）或新型方法（密苏里州软骨保存系统[MOPS]；71%）保存。所有病例的初始成功率为 79%，SP 为 60%，MOPS 为 84%。与 SP 病例相比，MOPS 病例显著（ =.028）更有可能获得成功的结果。所有队列的 PROMs 在 3 至 4 年的随访中均显著改善（ <.05）。19 例（10%）进行了翻修。MOPS 移植物的翻修率（5%）明显低于 SP 移植物（21%）（ =.0014）。26 例（13%）患者发生失败，均行全膝关节置换术。双极病例显著（ =.008）更有可能与失败相关。MOPS 移植物的失败率（11%）明显低于 SP 移植物（19%）（ =.048）。未遵守规定的康复方案与失败显著相关（ =.00008）。
194 例前瞻性数据显示，单极、多表面和双极软骨修复的 OCA 移植可始终获得成功的结果。5%的翻修率、11%的失败率、82%至 94%的生存率估计值以及术后 3 至 4 年持续改善的 PROMs，都凸显了与以往报告相比，结果有了重大进展。这些令人鼓舞的结果是使用新型移植物保存方法、供骨骨髓浓缩物预处理、移植物切割、植入和稳定技术的进步以及特定于手术的康复方案实现的。
