Guo Changjun, Li Xingchen, Zhu Yuan, Yang Chonglin, Xu Xiangyang
Department of Orthopaedics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Orthop J Sports Med. 2022 Sep 6;10(9):23259671221120075. doi: 10.1177/23259671221120075. eCollection 2022 Sep.
Autologous osteochondral transplantation (AOT) is a treatment option for large or cystic osteochondral lesions of the talus (OLTs), with promising clinical results. However, donor-site morbidity (DSM) has always been a concern with this procedure.
To investigate the clinical and radiological outcomes of autograft harvesting from the medial trochlea for OLTs.
Case series; Level of evidence, 4.
A total of 46 consecutive patients were included after AOT procedures for OLTs, with donor autografts (single or double plugs) harvested from the medial trochlea of the ipsilateral knee. Lysholm scores were collected postoperatively at 12-month intervals to assess clinical outcomes. Postoperative magnetic resonance imaging (MRI) was used to assess the donor site using the MOCART (magnetic resonance observation of cartilage repair tissue) score. DSM was evaluated at 12-month intervals. Statistical analysis was performed to compare patients treated with single-plug and double-plug AOT procedures and establish whether there was any correlation between MOCART and Lysholm scores.
The mean follow-up period was 98.3 months (range, 67-144 months). The Lysholm scores for all patients were 92.5 ± 6.1 and 99.9 ± 0.2 at the 12-month and final follow-ups, respectively. MRI of the donor sites was taken at an average of 93.8 ± 20.5 (range, 61-141) months postoperatively, and the mean MOCART score was 76.2 ± 4.9. The overall incidence of DSM in this study was 4.3% at 12 months, postoperatively, which decreased to 0% at the 24-month follow-up. There was no significant difference in either the Lysholm score ( = .16) or the MOCART score ( = .83) between the single-plug and double-plug groups at the final follow-up. There were no significant correlations between MOCART and Lysholm scores and patient age, number of grafts, or body mass index.
According to the study findings, the DSM of donor autografts harvested from the medial trochlea was low, and the number (single or double) of grafts did not affect the functional outcome.
自体骨软骨移植（AOT）是距骨大的或囊性骨软骨损伤（OLT）的一种治疗选择，临床效果良好。然而，供区并发症（DSM）一直是该手术令人担忧的问题。
研究取自内侧滑车的自体移植骨用于OLT的临床和影像学结果。
病例系列；证据等级，4级。
共有46例连续接受OLT的AOT手术患者纳入研究，供体自体移植物（单栓或双栓）取自同侧膝关节的内侧滑车。术后每隔12个月收集Lysholm评分以评估临床结果。术后磁共振成像（MRI）用于使用MOCART（软骨修复组织磁共振观察）评分评估供区。每隔12个月评估DSM。进行统计分析以比较接受单栓和双栓AOT手术的患者，并确定MOCART评分与Lysholm评分之间是否存在任何相关性。
平均随访期为98.3个月（范围67 - 144个月）。所有患者在术后12个月和最终随访时的Lysholm评分分别为92.5±6.1和99.9±0.2。供区MRI平均在术后93.8±20.5（范围61 - 141）个月进行，平均MOCART评分为76.2±4.9。本研究中DSM的总体发生率在术后12个月时为4.3%，在24个月随访时降至0%。在最终随访时，单栓组和双栓组之间的Lysholm评分（P = 0.16）或MOCART评分（P = 0.83）均无显著差异。MOCART评分与Lysholm评分和患者年龄、移植物数量或体重指数之间均无显著相关性。
根据研究结果，取自内侧滑车的供体自体移植物的DSM较低，移植物数量（单栓或双栓）不影响功能结果。
