Tisano Breann, Ellis Henry B, Wyatt Chuck, Wilson Philip L
University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Scottish Rite for Children Sports Medicine Campus, Frisco, Texas, USA.
Orthop J Sports Med. 2022 Feb 11;10(2):23259671211072515. doi: 10.1177/23259671211072515. eCollection 2022 Feb.
While an excellent option for osteochondral defects in the adult knee, fresh osteochondral allograft (FOCA) in the skeletally immature adolescent knee has been infrequently studied.
To compare radiographic and patient-reported outcomes (PROs) in skeletally mature and immature adolescents after FOCA in the knee for treatment of unsalvageable osteochondritis dissecans (OCD).
Cohort study; Level of evidence, 3.
Included were 34 patients (37 knees) who underwent size-matched FOCA of the knee for unsalvageable OCD lesions. All patients were aged ≤19 years and had a minimum of 12 months of follow-up. Patient characteristics, lesion characteristics, reoperations, and PROs were evaluated and compared between patients with open physes (skeletally immature; n = 20) and those with closed physes (skeletally mature; n = 17). Graft failure was defined as the need for revision osteochondral grafting. Postoperative radiographs were analyzed at 1 year and the final follow-up for graft incorporation and classified as A (complete), B (≥50% healed), or C (<50% healed).
The mean patient age was 15.4 years (range, 9.6-17.6 years), and the mean follow-up was 2.1 years (range, 1-5.3 years). The mean graft size was 5.0 cm and did not differ significantly between the study groups. Patients with open physes were younger (14.7 vs 16.2 years; = .002) and more commonly male (80% vs 35%; = .008). At the 1-year follow-up, 85% of immature patients and 82% of mature patients had radiographic healing grades of A or B. Patients with open physes were more likely to achieve complete radiographic union at 1 year (65% vs 15%; = .007) and demonstrated better Knee injury and Osteoarthritis Outcome Score (KOOS) Daily Living (96.8 vs 88.5; = .04) and KOOS Quality of Life (87.0 vs 56.8; = .01) at the final follow-up. Complications were no different in either group, and graft failure occurred in only 1 skeletally mature patient with a trochlear lesion.
FOCA treatment for unsalvageable OCD in the young knee may be expected to yield excellent early results. Despite the presence of open physes and immature epiphyseal osteochondral anatomy, equivalent or improved healing and PRO scores compared with those of skeletally mature patients may be expected.
虽然新鲜骨软骨移植（FOCA）是成人膝关节骨软骨缺损的一种极佳选择，但在骨骼未成熟的青少年膝关节中鲜少被研究。
比较骨骼成熟和未成熟青少年在膝关节进行FOCA治疗不可挽救的剥脱性骨软骨炎（OCD）后的影像学和患者报告结局（PROs）。
队列研究；证据等级，3级。
纳入34例患者（37个膝关节），这些患者因不可挽救的OCD损伤接受了尺寸匹配的膝关节FOCA。所有患者年龄≤19岁，且至少随访12个月。评估并比较了骨骺未闭合（骨骼未成熟；n = 20）和骨骺已闭合（骨骼成熟；n = 17）患者的患者特征、病变特征、再次手术情况和PROs。移植失败定义为需要进行翻修性骨软骨移植。在术后1年和末次随访时分析术后X线片，以评估移植物融合情况，并分为A（完全融合）、B（≥50%愈合）或C（<50%愈合）。
患者平均年龄为15.4岁（范围9.6 - 17.6岁），平均随访时间为2.1年（范围1 - 5.3年）。平均移植物大小为5.0 cm，研究组间无显著差异。骨骺未闭合的患者更年轻（14.7岁对16.2岁；P = 0.002），男性更常见（80%对35%；P = 0.008）。在1年随访时，85%的未成熟患者和82%的成熟患者影像学愈合等级为A或B。骨骺未闭合的患者在1年时更有可能实现完全影像学愈合（65%对15%；P = 0.007），且在末次随访时膝关节损伤和骨关节炎结局评分（KOOS）的日常生活方面（96.8对88.5；P = 0.04）和KOOS生活质量方面（87.0对56.8；P = 0.01）表现更好。两组并发症无差异，仅1例骨骼成熟且有滑车病变的患者发生了移植失败。
对于年轻膝关节不可挽救的OCD，FOCA治疗可能会取得优异的早期结果。尽管存在未闭合的骨骺和未成熟的骨骺骨软骨解剖结构，但与骨骼成熟的患者相比，预期愈合情况和PRO评分相当或更好。
