Cotter Eric J, Christian David R, Frank Rachel M, Abyar Eildar, Wischmeier Dillen, Yanke Adam B, Farr Jack, Cole Brian J
Department of Orthopaedic Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, U.S.A.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthrosc Sports Med Rehabil. 2019 Sep 26;1(1):e25-e34. doi: 10.1016/j.asmr.2019.06.003. eCollection 2019 Nov.
We performed a survivorship analysis of patients treated with patellofemoral osteochondral allograft transplantation (OCA) using either a shell or plug technique and identified variables associated with graft failure.
Consecutive patients at two institutions who underwent OCA of the patellofemoral compartment between March 1, 2001 to March 1, 2015, were retrospectively identified at minimum 2 years' follow-up. Demographic information, intraoperative findings, and postoperative data were collected. Patients were divided into two groups on the basis of surgical technique (plug group and shell group). Failure was defined as revision OCA, conversion to arthroplasty, or gross appearance of graft degeneration on second-look arthroscopy. Logistic regression analysis was performed to identify patient- and surgery-specific variables associated with survivorship.
Fifty patients were identified (36 women and 14 men; mean age 37.43 ± 8.87 years). Sixteen patients received plug allografts, whereas 34 received shell allografts. Forty percent of patients underwent a concomitant meniscal, ligamentous, malalignment, or chondral procedure. Five patients in the Plug Group (31.3%) underwent reoperation at a mean 1.37 ± 1.34 years, and 28 patients (82.4%) who received Shell OCA underwent reoperation at a mean 1.94 ± 1.92 years. Two patients in the plug group had graft failure at a mean 9.17 ± 0.93 years, whereas 13 patients in the shell group had graft failure at a mean 3.81 ± 2.78 years. Patients with plug allografts demonstrated 100% and 66% survival at 5 and 9.8 years, respectively. For the shell group, survivorship was 65.8% and 37% at 5 and 10.6 years, respectively. Increasing body mass index was associated with failure for the case series overall (odds ratio 1.33, = .020). Traumatic cause was found to be protective of failure (odds ratio = 0.02, = .035).
Plug OCA of the patellofemoral compartment can be an efficacious procedure with quality mid-term outcomes. Shell OCA led to high failure rates at midterm outcomes. Increasing body mass index may predispose patients to failure, whereas traumatic cause of their lesion was associated with improved outcomes.
Level IV, Therapeutic case series.
我们对采用骨块或骨栓技术进行髌股关节异体骨软骨移植（OCA）治疗的患者进行了生存分析，并确定了与移植物失败相关的变量。
回顾性纳入2001年3月1日至2015年3月1日期间在两家机构接受髌股关节OCA治疗且至少随访2年的连续患者。收集人口统计学信息、术中发现及术后数据。根据手术技术将患者分为两组（骨栓组和骨块组）。失败定义为再次进行OCA、转为关节成形术或二次关节镜检查时移植物明显退变。进行逻辑回归分析以确定与生存相关的患者及手术特异性变量。
共纳入50例患者（36例女性和14例男性；平均年龄37.43±8.87岁）。16例患者接受骨栓异体移植，34例接受骨块异体移植。40%的患者同时进行了半月板、韧带、对线不良或软骨手术。骨栓组5例患者（31.3%）平均在1.37±1.34年时再次手术，接受骨块OCA的28例患者（82.4%）平均在1.94±1.92年时再次手术。骨栓组2例患者平均在9.17±0.93年时移植物失败，而骨块组13例患者平均在3.81±2.78年时移植物失败。骨栓异体移植患者在5年和9.8年时的生存率分别为100%和66%。对于骨块组，5年和10.6年时的生存率分别为65.8%和37%。总体病例系列中，体重指数增加与失败相关（比值比1.33，P = 0.020）。发现创伤性病因可预防失败（比值比 = 0.02，P = 0.035）。
髌股关节骨栓OCA可能是一种有效的手术，中期效果良好。骨块OCA中期失败率较高。体重指数增加可能使患者易于失败，而创伤性病因与较好的预后相关。
IV级，治疗性病例系列。
