半月板同种异体移植手术的结果：何为成功？
The results of meniscal allograft transplantation surgery: what is success?
机构信息
University of Edinburgh Medical School, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland.
London Sports Orthopaedics, 31 Old Broad Street, London, EC2N 1HT, England.
出版信息
BMC Musculoskelet Disord. 2020 Mar 12;21(1):159. doi: 10.1186/s12891-020-3165-0.
BACKGROUND
Meniscal allograft transplantation (MAT) may improve symptoms and function, and may limit premature knee degeneration in patients with symptomatic meniscal loss. The aim of this retrospective study was to examine patient outcomes after MAT and to explore the different potential definitions of 'success' and 'failure'.
METHODS
Sixty patients who underwent MAT between 2008 and 2014, aged 18-50 were identified. Six validated outcome measures for knee pathologies, patient satisfaction and return to sport were incorporated into a questionnaire. Surgical failure (removal of most/all the graft, revision MAT or conversion to arthroplasty), clinical failure (Lysholm < 65), complication rates (surgical failure plus repeat arthroscopy for secondary allograft tears) and whether patients would have the procedure again were recorded. Statistics analysis included descriptive statistics, with patient-reported outcome measures reported as median and range. A binomial logistic regression was performed to assess factors contributing to failure.
RESULTS
Forty-three patients (72%) responded, mean age 35.6 (±7.5). 72% required concomitant procedures, and 44% had Outerbridge III or IV chondral damage. The complication rate was 21% (9). At mean follow-up of 3.4 (±1.6) years, 9% (4) were surgical failures and 21% (9) were clinical failures. Half of those patients considered a failure stated they would undergo MAT again. In the 74% (32) reporting they would undergo MAT again, median KOOS, IKDC and Lysholm scores were 82.1, 62.1 and 88, compared to 62.2, 48.5 and 64 in patients who said they would not. None of the risk factors significantly contributed to surgical or clinical failure, although female gender and number of concomitant procedures were nearly significant. Following MAT, 40% were dissatisfied with type/level of sport achieved, but only 14% would not consider MAT again.
CONCLUSIONS
None of the risk factors examined were linked to surgical or clinical failure. Whilst less favourable outcomes are seen with Outerbridge Grade IV, these patients should not be excluded from potential MAT. Inability to return to sport is not associated with failure since 73% of these patients would undergo MAT again. The disparity between 'clinical failure' and 'surgical failure' outcomes means these terms may need re-defining using a specific/bespoke MAT scoring system.
背景
半月板同种异体移植（MAT）可能改善症状和功能，并可能限制有症状的半月板丧失患者的早期膝关节退化。本回顾性研究旨在检查 MAT 后的患者结局，并探讨不同的“成功”和“失败”定义。
方法
确定了 2008 年至 2014 年间接受 MAT 的 60 名年龄在 18-50 岁之间的患者。纳入了 6 种膝关节病变的有效评估方法、患者满意度和重返运动情况的问卷。记录了手术失败（大部分/全部移植物移除、再次 MAT 或转为关节置换术）、临床失败（Lysholm <65）、并发症发生率（手术失败加二次移植物撕裂的再次关节镜检查）和患者是否会再次接受手术。统计分析包括描述性统计，患者报告的结果测量值以中位数和范围表示。采用二项逻辑回归分析评估导致失败的因素。
结果
43 名患者（72%）做出了回应，平均年龄 35.6（±7.5）岁。72%需要同时进行手术，44%有 Outerbridge III 或 IV 级软骨损伤。并发症发生率为 21%（9 例）。平均随访 3.4（±1.6）年后，9%（4 例）发生手术失败，21%（9 例）发生临床失败。半数认为失败的患者表示会再次接受 MAT。在 74%（32 例）表示会再次接受 MAT 的患者中，KOOS、IKDC 和 Lysholm 评分中位数分别为 82.1、62.1 和 88，而不会再次接受 MAT 的患者分别为 62.2、48.5 和 64。尽管女性性别和同时进行的手术数量接近显著，但没有任何危险因素显著导致手术或临床失败。MAT 后，40%的患者对达到的运动类型/水平不满意，但只有 14%不会再次考虑 MAT。
结论
没有一个研究的危险因素与手术或临床失败有关。虽然 Outerbridge 分级 IV 患者的预后较差，但不应将这些患者排除在潜在的 MAT 之外。无法重返运动与失败无关，因为这些患者中有 73%会再次接受 MAT。“临床失败”和“手术失败”结果之间的差异意味着这些术语可能需要使用特定的 MAT 评分系统重新定义。
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