McKeon Brian P, Zaslav Kenneth R, Alfred Richard H, Alley R Maxwell, Edelson Richard H, Gersoff Wayne K, Greenleaf Jonathan E, Kaeding Christopher C
Boston Sports & Shoulder Center, Waltham, Massachusetts, USA.
Ortho Virginia, Virginia Commonwealth University, Richmond, Virginia, USA.
Orthop J Sports Med. 2020 Sep 29;8(9):2325967120952414. doi: 10.1177/2325967120952414. eCollection 2020 Sep.
At least 760,000 outpatient meniscectomies are performed in the United States each year, making this the most common musculoskeletal procedure. However, meniscal resection can alter the joint biomechanics and overload the articular cartilage, which may contribute to degenerative changes and the need for knee replacement. Avoiding or delaying knee replacement is particularly important in younger or more active patients. Synthetic meniscal implants have been developed in an attempt to restore the natural joint biomechanics, alleviate pain and disability, and potentially minimize degenerative changes in patients who require meniscectomy.
To evaluate the preliminary results from 2 ongoing trials that are evaluating the safety and effectiveness of a synthetic polymer meniscal implant (NUsurface; Active Implants, LLC).
Cohort study; Level of evidence, 2.
This was a preliminary analysis of the first 100 patients enrolled across 2 studies for 12 months: a single-arm, intervention-only study and a randomized controlled trial comparing the investigational meniscal implant with nonsurgical therapy. There were 65 patients in the implant group (30 randomized) and 35 in the control group. Outcomes included Knee injury and Osteoarthritis Outcome Score (KOOS) and adverse events (AEs) collected at baseline and follow-up visits of 6 weeks, 6 months, and 12 months.
No statistically significant differences were found in baseline characteristics between the implant and control groups. At 12 months, follow-up KOOS data were available for 87% of the 100 included patients. Significantly greater improvements from baseline were observed in the implant group compared with controls in all KOOS subcomponents, except for symptoms (119%-177% greater improvement at 12 months). AEs were reported at similar rates between the 2 groups, with 12 AEs among 11 patients in the implant group (16.9%) versus 5 AEs among 5 patients (14.3%) in the control group ( = .99).
These preliminary results suggest significant improvements in pain and function scores with the implant over nonsurgical therapy and a similar adverse event rate.
在美国,每年至少进行76万例门诊半月板切除术,使其成为最常见的肌肉骨骼手术。然而,半月板切除术会改变关节生物力学并使关节软骨过载,这可能导致退行性改变以及需要进行膝关节置换。对于年轻或活动较多的患者而言,避免或推迟膝关节置换尤为重要。人们已研发出合成半月板植入物,试图恢复自然的关节生物力学,减轻疼痛和残疾,并有可能将需要进行半月板切除术患者的退行性改变降至最低。
评估两项正在进行的试验的初步结果,这两项试验正在评估一种合成聚合物半月板植入物(NUsurface;Active Implants,LLC)的安全性和有效性。
队列研究;证据等级,2级。
这是对两项研究中首批入组的100例患者进行12个月的初步分析:一项单臂、仅干预性研究以及一项将研究性半月板植入物与非手术治疗进行比较的随机对照试验。植入组有65例患者(30例为随机分组),对照组有35例患者。结局指标包括在基线以及6周、6个月和12个月随访时收集的膝关节损伤和骨关节炎结局评分(KOOS)以及不良事件(AE)。
植入组和对照组在基线特征方面未发现统计学上的显著差异。在12个月时,100例纳入患者中有87%的患者可获得随访KOOS数据。与对照组相比,植入组在所有KOOS子成分中均观察到自基线起有显著更大的改善,但症状方面除外(12个月时改善程度高出119% - 177%)。两组报告AE的发生率相似,植入组11例患者中有12例发生AE(16.9%),而对照组5例患者中有5例发生AE(14.3%)(P = 0.99)。
这些初步结果表明,与非手术治疗相比,植入物在疼痛和功能评分方面有显著改善,且不良事件发生率相似。