Cook James L, Rucinski Kylee, Crecelius Cory R, Ma Richard, Stannard James P
Mizzou BioJoint Center, Missouri Orthopaedic Institute, University of Missouri-Columbia, Columbia, Missouri, USA.
Orthop J Sports Med. 2021 Jan 22;9(1):2325967120967928. doi: 10.1177/2325967120967928. eCollection 2021 Jan.
Return to sport (RTS) after osteochondral allograft (OCA) transplantation for large unipolar femoral condyle defects has been consistent, but many athletes are affected by more severe lesions.
To examine outcomes for athletes who have undergone large single-surface, multisurface, or bipolar shell OCA transplantation in the knee.
Case series; Level of evidence, 4.
Data from a prospective OCA transplantation registry were assessed for athletes who underwent knee transplantation for the first time (primary transplant) between June 2015 and March 2018 for injury or overuse-related articular defects. Inclusion criteria were preinjury Tegner level ≥5 and documented type and level of sport (or elite unit active military duty); in addition, patients were required to have a minimum of 1-year follow-up outcomes, including RTS data. Patient characteristics, surgery type, Tegner level, RTS, patient-reported outcome measures (PROMs), compliance with rehabilitation, revisions, and failures were assessed and compared for statistically significant differences.
There were 37 included athletes (mean age, 34 years; range, 15-69 years; mean body mass index, 26.2 kg/m; range, 18-35 kg/m) who underwent large single-surface (n = 17), multisurface (n = 4), or bipolar (n = 16) OCA transplantation. The highest preinjury median Tegner level was 9 (mean, 7.9 ± 1.7; range, 5-10). At the final follow-up, 25 patients (68%) had returned to sport; 17 (68%) returned to the same or higher level of sport compared with the highest preinjury level. The median time to RTS was 16 months (range, 7-26 months). Elite unit military, competitive collegiate, and competitive high school athletes returned at a significantly higher proportion ( < .046) than did recreational athletes. For all patients, the Tegner level at the final follow-up (median, 6; mean, 6.1 ± 2.7; range, 1-10) was significantly lower than that at the highest preinjury level ( = .007). PROMs were significantly improved at the final follow-up compared with preoperative levels and reached or exceeded clinically meaningful differences. OCA revisions were performed in 2 patients (5%), and failures requiring total knee arthroplasty occurred in 2 patients (5%), all of whom were recreational athletes. Noncompliance was documented in 4 athletes (11%) and was 15.5 times more likely ( = .049) to be associated with failure or a need for revision than for compliant patients.
Large single-surface, multisurface, or bipolar shell OCA knee transplantations in athletes resulted in two-thirds of these patients returning to sport at 16 to 24 months after transplantation. Combined, the revision and failure rates were 10%; thus, 90% of patients were considered to have successful 2- to 4-year outcomes with significant improvements in pain and function, even when patients did not RTS.
对于大型单极股骨髁缺损行同种异体骨软骨移植（OCA）后恢复运动（RTS）情况一直较为稳定，但许多运动员受更严重损伤影响。
研究接受膝关节大型单表面、多表面或双极壳OCA移植的运动员的预后情况。
病例系列；证据等级，4级。
对前瞻性OCA移植登记处的数据进行评估，纳入2015年6月至2018年3月因损伤或过度使用相关关节缺损首次接受膝关节移植（初次移植）的运动员。纳入标准为伤前Tegner水平≥5且记录有运动类型和水平（或精英部队现役军人）；此外，患者需至少有1年的随访结果，包括RTS数据。评估患者特征、手术类型、Tegner水平、RTS、患者报告结局指标（PROMs）、康复依从性、翻修情况及失败情况，并比较是否存在统计学显著差异。
共纳入37名运动员（平均年龄34岁；范围15 - 69岁；平均体重指数26.2 kg/m；范围18 - 35 kg/m），他们接受了大型单表面（n = 17）、多表面（n = 4）或双极（n = 16）OCA移植。伤前最高中位Tegner水平为9（平均7.9 ± 1.7；范围5 - 10）。在最后一次随访时，25名患者（68%）恢复运动；17名（68%）恢复到与伤前最高水平相同或更高水平的运动。RTS的中位时间为16个月（范围7 - 26个月）。精英部队军人、大学竞技运动员和高中竞技运动员恢复运动的比例显著高于休闲运动员（P <.046）。所有患者最后一次随访时的Tegner水平（中位值6；平均6.1 ± 2.7；范围1 - 10）显著低于伤前最高水平（P =.007）。与术前水平相比，最后一次随访时PROMs显著改善，达到或超过临床有意义的差异。2名患者（5%）进行了OCA翻修，2名患者（5%）出现需要全膝关节置换的失败情况，所有这些患者均为休闲运动员。4名运动员（11%）记录有不依从情况，与依从患者相比，不依从患者失败或需要翻修的可能性高15.5倍（P =.049）。
运动员接受大型单表面、多表面或双极壳OCA膝关节移植后，三分之二的患者在移植后16至24个月恢复运动。综合来看，翻修率和失败率为10%；因此，90%的患者被认为在2至4年的结局中取得成功，疼痛和功能有显著改善，即使患者未恢复运动。
