比较冷冻与新鲜半月板同种异体移植的初步临床结果。
Initial clinical outcomes comparing frozen versus fresh meniscus allograft transplants.
机构信息
Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA.
Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA; Mizzou BioJoint Center, University of Missouri Department of Orthopaedic Surgery, Columbia, MO, USA.
出版信息
Knee. 2020 Dec;27(6):1811-1820. doi: 10.1016/j.knee.2020.09.015. Epub 2020 Nov 13.
BACKGROUND
To evaluate initial clinical outcomes using fresh meniscal allografts with high cell viability at transplantation time and meniscotibial ligament (MTL) reconstruction (Fresh) in comparison to standard fresh-frozen (Frozen) meniscus allograft transplantation (MAT).
METHODS
Patients treated for medial and/or lateral meniscal deficiency using either Fresh or Frozen MAT with minimum of 1-year follow-up were identified from a prospective registry. Patient demographics, prior surgeries, MAT surgery data, complications, revisions, and failures were documented. Functional outcome scores were collected preoperatively, and 6 months and yearly after surgery and radiographic joint space measurements were performed. Treatment cohorts were compared for statistically significant (P < 0.005) differences using t-Tests and Fisher's exact tests.
RESULTS
Twenty-seven patients (14 Fresh, 13 Frozen) met inclusion criteria and showed comparable characteristics. For Fresh MAT + MTL, 10 medial, two lateral, and two medial + lateral MAT were performed. For Frozen MAT, nine medial, and four lateral MAT were performed. There was significantly more improvement in the Fresh cohort compared to the Frozen cohort for VAS pain (P = 0.014), PROMIS Physical Function (P = 0.036) and Single Assessment Numeric Evaluation (P = 0.033) from preoperatively to 2 years postoperatively. Tegner Activity Scale and PROMIS Mobility score showed no significant differences. The International Knee Documentation Committee score revealed a clinically meaningful change for the Fresh group. Radiographic measurements showed no significant differences between groups. There were two Fresh MAT + MTL revisions and one conversion to TKA in each cohort.
CONCLUSIONS
Fresh MAT + MTL is safe and associated with potential advantages with respect to initial pain relief and function compared to standard frozen MAT.
背景
为了评估在移植时具有高细胞活力的新鲜半月板同种异体移植物和半月板胫腓韧带（MTL）重建（新鲜）与标准新鲜冷冻（冷冻）半月板同种异体移植（MAT）相比的初始临床结果。
方法
从前瞻性登记处确定了使用新鲜或冷冻 MAT 治疗内侧和/或外侧半月板缺失的患者，随访时间至少为 1 年。记录患者的人口统计学资料、既往手术、MAT 手术数据、并发症、翻修和失败情况。收集术前、术后 6 个月和每年的功能结果评分，并进行影像学关节间隙测量。使用 t 检验和 Fisher 确切检验比较治疗队列之间的统计学显著（P<0.005）差异。
结果
27 名患者（14 名新鲜，13 名冷冻）符合纳入标准，表现出相似的特征。对于新鲜 MAT+MTL，进行了 10 例内侧、2 例外侧和 2 例内侧+外侧 MAT。对于冷冻 MAT，进行了 9 例内侧和 4 例外侧 MAT。与冷冻组相比，新鲜组在 VAS 疼痛（P=0.014）、PROMIS 身体机能（P=0.036）和单一评估数字评估（P=0.033）方面的术后 2 年随访中有显著改善。Tegner 活动量表和 PROMIS 活动评分无显著差异。国际膝关节文献委员会评分显示新鲜组有临床意义的变化。影像学测量两组间无显著差异。每个队列都有 2 例新鲜 MAT+MTL 翻修和 1 例转换为 TKA。
结论
新鲜 MAT+MTL 是安全的，与标准冷冻 MAT 相比，在初始缓解疼痛和功能方面具有潜在优势。
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