Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Mizzou BioJoint Center, University of Missouri, Columbia, MO, USA.
Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA; Mizzou BioJoint Center, University of Missouri, Columbia, MO, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA.
Knee. 2021 Jan;28:207-213. doi: 10.1016/j.knee.2020.12.004. Epub 2021 Jan 5.
Our study purpose was to determine if primary osteochondral allograft (OCA) transplant surgeries for large (>4 cm) single-surface, multisurface, or bipolar articular defects in the knee would be associated with significant gains in knee range of motion (ROM) at ≥1-year follow-up when compared to preoperative ROM.
Patients were prospectively enrolled into a dedicated registry to follow outcomes after OCA with or without meniscal allograft transplantation using Missouri Osteochondral Preservation System (MOPS)-preserved allografts. Patients were included if they had surgery to repair at least one osteochondral defect, and when at least one year of ROM data and Visual Analog Scale pain scores were available. Data on complications and reoperations, patient-reported outcome measures, compliance with rehabilitation, revisions, or failures were recorded.
For patients who met inclusion criteria after OCA surgery (n = 75), overall ROM increased from 127.8 ± 17 degrees preoperatively, to 130.5 ± 14 post-operatively. Non-compliance was the largest factor contributing to postoperative ROM lag or loss. Knee manipulation/lysis of adhesion rates were comparable to rates in TKA and ACL procedures (2.96-4.54% for ACL/TKA, 4% for OCAs in the present study).
Results suggest that OCA with or without meniscal allograft transplantation in the knee using high-viability grafts, advanced graft cutting and implantation techniques, and procedure-specific rehabilitation protocols can result in consistently successful outcomes in a high percentage (92%) of selected patients. Most patients (95%) can expect to regain, or improve, to "full" functional range of motion (130°) at 1 year after surgery such that highly functional activities can be performed.
Cohort study; Level III.
本研究旨在确定膝关节内大于 4cm 的单一表面、多表面或双极关节面骨软骨缺损行初次同种异体骨软骨移植（OCA）手术是否会比术前 ROM 有显著的膝关节活动度（ROM）增加，随访时间至少 1 年。
患者前瞻性地入组专门的登记处，以随访使用密苏里州软骨保存系统（MOPS）保存的同种异体移植物进行 OCA 或半月板同种异体移植的患者的结局。如果患者至少有一处骨软骨缺损修复手术，且至少有 1 年的 ROM 数据和视觉模拟量表疼痛评分，则将其纳入研究。记录并发症和再次手术、患者报告的结局测量、康复依从性、翻修或失败的数据。
在 OCA 手术后符合纳入标准的患者（n=75）中，总体 ROM 从术前的 127.8±17 度增加到术后的 130.5±14 度。术后 ROM 延迟或丢失的最大因素是不依从。膝关节松解术/粘连松解率与 TKA 和 ACL 手术相似（ACL/TKA 为 2.96%-4.54%，本研究中 OCA 为 4%）。
结果表明，膝关节内使用高活力移植物、先进的移植物切割和植入技术以及特定手术的康复方案进行 OCA 或半月板同种异体移植，可以使 92%的选定患者获得一致成功的结果。大多数患者（95%）在术后 1 年可以恢复或改善至“完全”功能活动范围（130°），从而可以进行高度功能活动。
队列研究；III 级。
