Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC.
Campbell University School of Osteopathic Medicine, Lillington, NC.
Foot Ankle Int. 2022 Jul;43(7):899-912. doi: 10.1177/10711007221088033. Epub 2022 May 2.
In cases of large osteochondral lesions of the talus (OLTs), fresh structural or bulk osteochondral allograft transplantation has yielded favorable outcomes in several retrospective and few prospective case series. The purpose of this study was to prospectively evaluate patients who received fresh structural allograft transplantation of the talar shoulder.
A prospective evaluation of patients who received a fresh structural allograft of an OLT was performed. Preoperative imaging included magnetic resonance imaging (MRI) and/or computed tomography (CT) with plain radiographs. The following patient-reported outcomes questionnaires were administered preoperatively and yearly after surgery: 36-Item Short-Form Health Survey (SF-36), visual analog scale (VAS) for pain, and the Short Musculoskeletal Functional Assessment (SMFA). Preoperative and postoperative imaging were evaluated for allograft assimilation, evidence of arthritic changes, or functional range of motion abnormalities.
Thirty-one patients with a mean age of 41.4 years (±14.1, range 18-69) underwent structural fresh osteochondral allograft transplantation to the talar shoulder and were included in this study. The mean follow-up was 56.2 months (±36.1, range 24-142). The majority of patients were female (n=17, 54.8%), reported some history of prior ankle trauma (n=21, 67.7%), and underwent prior ankle surgery (n=23, 74.2%). The mean lesion size on CT scan was 1879 mm (n = 27) compared to the mean lesion size of 3877 mm (n = 21) on MRI. There was a significant improvement in the mean preoperative VAS score ( < .0001), SF-36 score ( < .0005), SMFA bother index ( < .0015), and the SMFA function index ( < .0001) at final follow-up. A total of 15 (48.4%) patients underwent an additional surgery following their osteochondral allograft transplant, most commonly arthroscopic debridement or removal of hardware, performed at an average of 25.2 (±13.0) from their index procedure. There was one failure that required a total ankle replacement. The overall graft survival rate was 96.8%.
Fresh, structural allograft transplantation resulted in significant improvement in patient-reported postoperative pain and function in patients suffering from OLTs. The graft survival rate was 96.8% at a mean of 56.2 months follow-up, with half of patients requiring a second procedure.
Level IV, prospective case series.
在距骨大骨软骨病变（OLTs）的情况下，新鲜的结构性或大块骨软骨同种异体移植在几项回顾性和少数前瞻性病例系列中取得了良好的结果。本研究的目的是前瞻性评估接受距骨肩新鲜结构性同种异体移植物移植的患者。
对接受 OLT 新鲜结构性同种异体移植的患者进行前瞻性评估。术前影像学检查包括磁共振成像（MRI）和/或计算机断层扫描（CT）加平片。术前和术后每年进行以下患者报告的结果问卷评估：36-项简短健康调查问卷（SF-36）、疼痛视觉模拟量表（VAS）和短肌肉骨骼功能评估（SMFA）。评估同种异体移植物吸收、关节炎变化证据或功能运动范围异常的术前和术后影像学。
31 名平均年龄为 41.4 岁（±14.1，范围 18-69）的患者接受了距骨肩的结构性新鲜骨软骨同种异体移植，并纳入本研究。平均随访时间为 56.2 个月（±36.1，范围 24-142）。大多数患者为女性（n=17，54.8%），报告有一些既往踝关节外伤史（n=21，67.7%），并接受过既往踝关节手术（n=23，74.2%）。CT 扫描上的平均病变大小为 1879mm（n=27），而 MRI 上的平均病变大小为 3877mm（n=21）。最终随访时，VAS 评分（<.0001）、SF-36 评分（<.0005）、SMFA 困扰指数（<.0015）和 SMFA 功能指数（<.0001）均有显著改善。共有 15 名（48.4%）患者在接受同种异体移植物移植后接受了额外的手术，最常见的是关节镜下清创术或去除内固定物，平均在指数手术后 25.2（±13.0）进行。有 1 例失败，需要全踝关节置换。总体移植物存活率为 96.8%。
新鲜的结构性同种异体移植可显著改善 OLT 患者的术后疼痛和功能的患者报告结果。在平均 56.2 个月的随访中，移植物存活率为 96.8%，有一半患者需要进行第二次手术。
IV 级，前瞻性病例系列。
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