NYU Langone Health, New York, New York, U.S.A.
East River Medical Imaging, New York, New York, U.S.A.
Arthroscopy. 2021 Jul;37(7):2262-2269. doi: 10.1016/j.arthro.2021.03.032. Epub 2021 Mar 24.
To evaluate the effectiveness of extracellular matrix cartilage allograft (EMCA) as an adjuvant to bone marrow stimulation (BMS) compared with BMS alone in the treatment of osteochondral lesions of the talus.
A retrospective cohort study comparing patients treated with BMS with EMCA (BMS-EMCA group) and BMS alone (BMS group) between 2013 and 2019 was undertaken. Clinical outcomes were evaluated with the Foot and Ankle Outcome Score (FAOS) preoperatively and postoperatively. Postoperative magnetic resonance imaging (MRI) scans were evaluated using the modified Magnetic Resonance Observation of Cartilage Repair Tissue score. Comparisons between groups were made with the Mann-Whitney U test for continuous variables and the Fisher exact test for categorical variables.
Twenty-four patients underwent BMS with EMCA (BMS-EMCA group), and 24 patients underwent BMS alone (BMS group). The mean age was 40.8 years (range, 19-60 years) in the BMS-EMCA group and 47.8 years (range, 24-60 years) in the BMS group (P = .060). The mean follow-up time was 20.0 months (range, 12-36 months) in the BMS-EMCA group and 26.9 months (range, 12-55 months) in the BMS group (P = .031). Both groups showed significant improvements in all FAOS subscales. No significant differences between groups were found in all postoperative FAOS values. The mean Magnetic Resonance Observation of Cartilage Repair Tissue score in the BMS-EMCA group was higher (76.3 vs 66.3) but not statistically significant (P = .176). The MRI analysis showed that 87.5% of the BMS-EMCA patients had complete infill of the defect with repair tissue; however, fewer than half of the BMS patients (46.5%) had complete infill (P = .015).
BMS with EMCA is an effective treatment strategy for osteochondral lesions of the talus and provides better cartilage infill in the defect on MRI. However, this did not translate to improved functional outcomes compared with BMS alone in the short term. Additionally, according to analysis of the minimal clinically important difference, there was no significant difference in clinical function scoring between the 2 groups postoperatively.
Level III, retrospective comparative study.
评估细胞外基质软骨同种异体移植物（EMCA）作为骨髓刺激（BMS）辅助治疗距骨骨软骨病变的疗效，与单独 BMS 治疗相比。
回顾性队列研究比较了 2013 年至 2019 年期间接受 BMS 联合 EMCA（BMS-EMCA 组）和单独 BMS（BMS 组）治疗的患者。临床结果采用足踝结局评分（FAOS）进行评估，术前和术后进行评估。术后磁共振成像（MRI）扫描采用改良的磁共振软骨修复组织评分进行评估。采用 Mann-Whitney U 检验进行连续变量比较，Fisher 确切概率检验进行分类变量比较。
24 例患者接受 BMS 联合 EMCA（BMS-EMCA 组），24 例患者接受单独 BMS（BMS 组）。BMS-EMCA 组的平均年龄为 40.8 岁（19-60 岁），BMS 组为 47.8 岁（24-60 岁）（P=0.060）。BMS-EMCA 组的平均随访时间为 20.0 个月（12-36 个月），BMS 组为 26.9 个月（12-55 个月）（P=0.031）。两组 FAOS 各亚量表均有显著改善。组间术后 FAOS 值无显著差异。BMS-EMCA 组的平均磁共振软骨修复组织评分较高（76.3 比 66.3），但无统计学意义（P=0.176）。MRI 分析显示，87.5%的 BMS-EMCA 患者缺损处有完整的修复组织填充；然而，只有不到一半的 BMS 患者（46.5%）有完整的填充（P=0.015）。
BMS 联合 EMCA 是治疗距骨骨软骨病变的有效治疗策略，可在 MRI 上提供更好的软骨缺损填充。然而，与单独 BMS 相比，短期内在功能结果上并没有改善。此外，根据最小临床重要差异分析，术后两组在临床功能评分上没有显著差异。
III 级，回顾性比较研究。
