Cook James L, Rucinski Kylee, Crecelius Cory, Fenkell Blake, Stannard James P
Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA.
Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.
Orthop J Sports Med. 2022 Jun 14;10(6):23259671221102452. doi: 10.1177/23259671221102452. eCollection 2022 Jun.
Treatment of multisurface articular cartilage lesions of the knee is a challenging problem.
Large multisurface cartilage defects in the knee can be successfully managed with transplantation of high chondrocyte viability osteochondral allografts (OCAs) to result in statistically significant improvements in patient-reported outcome measures of pain and function.
Cohort study; Level of evidence, 3.
Patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. The study included patients who received OCA transplantation for multisurface unipolar defects in 1 knee and had minimum 2-year follow-up data, including patient-reported outcome measures, failures, reoperations, and complications. The OCA transplants had been stored using 2 methods: standard preservation (SP) or Missouri Osteochondral Preservation System (MOPS). Preoperative data were compared with outcomes at 1 year and final follow-up, and risk factors for revision surgery or failure (total knee arthroplasty) were analyzed.
The sample included 25 patients with a mean age of 37.2 years (range, 13-51 years), body mass index of 27.7 (range, 18-38), and follow-up of 45.1 months (median, 49 months; range, 24-68 months). OCAs stored using SP were transplanted into 6 patients, and those stored using MOPS were transplanted into 19 patients. The initial success rate was significantly higher for MOPS OCAs (94.7%) than SP OCAs (33.3%). There were statistically significant improvements in all patient-reported outcomes at 1 year and final follow-up in the MOPS cohort ( < .0001 for all). Revision surgery/failure was significantly associated with patients who were nonadherent to the prescribed postoperative restrictions and rehabilitation protocols ( = .038; odds ratio = 13.5) and with OCAs that had a viable chondrocyte density <70% of the established reference range mean at transplantation ( = .0037; odds ratio = 76).
OCA transplantation for treatment of large multisurface cartilage defects in the knee resulted in a 94.7% initial success rate when grafts with high viable chondrocyte density (≥70%) were used and when patients strictly adhered to prescribed postoperative rehabilitation protocols. Successful outcomes were associated with statistically significant improvements in patient-reported outcome measures of pain and function.
膝关节多表面关节软骨损伤的治疗是一个具有挑战性的问题。
通过移植具有高软骨细胞活力的异体骨软骨移植体（OCA），可成功治疗膝关节大面积多表面软骨缺损，从而使患者报告的疼痛和功能结局指标在统计学上有显著改善。
队列研究；证据等级，3级。
前瞻性地将患者纳入登记系统，以跟踪OCA移植后的结局。该研究纳入了因单膝关节多表面缺损接受OCA移植且有至少2年随访数据的患者，包括患者报告的结局指标、失败情况、再次手术和并发症。OCA移植体采用两种方法保存：标准保存（SP）或密苏里骨软骨保存系统（MOPS）。将术前数据与1年时及最终随访时的结局进行比较，并分析翻修手术或失败（全膝关节置换术）的危险因素。
样本包括25例患者，平均年龄37.2岁（范围13 - 51岁），体重指数27.7（范围18 - 38），随访45.1个月（中位数49个月；范围24 - 68个月）。采用SP保存的OCA移植到6例患者，采用MOPS保存的OCA移植到19例患者。MOPS OCA的初始成功率（94.7%）显著高于SP OCA（33.3%）。在MOPS队列中，1年时及最终随访时所有患者报告的结局均有统计学显著改善（所有P值均<0.0001）。翻修手术/失败与未遵守规定的术后限制和康复方案的患者显著相关（P = 0.038；比值比 = 13.5），也与移植时软骨细胞活力密度<既定参考范围平均值70%的OCA显著相关（P = 0.0037；比值比 = 76）。
当使用具有高活力软骨细胞密度（≥70%）的移植物且患者严格遵守规定的术后康复方案时，OCA移植治疗膝关节大面积多表面软骨缺损的初始成功率为94.7%。成功的结局与患者报告的疼痛和功能结局指标在统计学上的显著改善相关。
