Buyuk Abdul Fettah, Stannard James P, Rucinski Kylee, Crecelius Cory R, Cook James L
Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.
Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA.
Arthroscopy. 2023 Mar;39(3):650-659. doi: 10.1016/j.arthro.2022.10.007. Epub 2022 Oct 25.
To compare outcomes after whole-surface osteochondral allograft (OCA) transplantation using shell grafts for treatment of patellofemoral joint lesions with respect to surfaces treated and OCA preservation method.
With institutional review board approval and informed consent, patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. Patients who received patellofemoral shell OCA to treat the entire articular surface of the patella, trochlea, or both, and with a minimum of 2-year follow-up data, including patient-reported outcome measures (PROMs), failures, and complications, were included. Functional graft survival was determined based on patients returning to functional activities without need for OCA revision or arthroplasty surgery and calculated using the formula: 100% - (%revision + %failure). Minimum clinically important differences were determined based on previously validated data. Outcomes were compared based on differences in graft preservation methodology (Missouri Osteochondral Preservation System [MOPS] or standard preservation [SP]) and based on surfaces treated (patella, trochlea, or both).
Fifty-eight patients met inclusion criteria. Mean age was 36.7 years (range 15-60 years) and mean body mass index was 28.9 (range 18-42). OCAs stored using SP methods were transplanted in 12 patients, mean follow-up was (66.1 months; range 54-70 months): OCAs stored using MOPS methods were transplanted in 46 patients, mean follow-up was (44.8 months; range 24-60 months). Graft survival rate at final follow-up was significantly greater (P = .025) for MOPS OCAs (98%) compared with SP OCAs (75%), whereas 2-year functional graft survival rates (MOPS 98% vs SP 83%; P = .1) were not. Reoperation rate was significantly greater (P = .0014) for SP cases compared with MOPS cases. PROMs showed statistically significant and clinically meaningful improvements through 4 years after unipolar patella, unipolar trochlea, and bipolar patellofemoral OCA transplantation using MOPS grafts. Unipolar patella OCA transplantations were associated with significantly more reduction in pain and significantly better PROMs at 1-year compared with unipolar trochlea and bipolar patellofemoral OCAs.
OCA transplantation using MOPS shell grafts for unipolar and bipolar patellofemoral resurfacing was associated with statistically significant and clinically meaningful improvements from preoperative levels of pain and function. The 2-year functional graft survival rate was 83% in the SP group and 98% in the MOPS group, such that MOPS was associated with better short-term outcomes than SP methods when performing OCA transplantation using shell grafts for patellofemoral lesions. Patients who received unipolar patella allografts reported the best outcomes in terms of pain and function.
Level III, retrospective analysis of registry data.
比较使用壳状移植物进行全表面骨软骨异体移植（OCA）治疗髌股关节损伤后的结果，比较不同治疗表面及OCA保存方法的疗效。
经机构审查委员会批准并获得知情同意后，患者被前瞻性纳入登记系统以跟踪OCA移植后的结果。纳入接受髌股关节壳状OCA治疗髌骨、滑车或两者的整个关节表面且至少有2年随访数据的患者，数据包括患者报告的结局指标（PROMs）、失败情况和并发症。功能性移植物存活率根据患者恢复功能活动且无需进行OCA翻修或关节成形术来确定，并使用公式计算：100% - （%翻修 + %失败）。根据先前验证的数据确定最小临床重要差异。根据移植物保存方法（密苏里骨软骨保存系统[MOPS]或标准保存[SP]）和治疗表面（髌骨、滑车或两者）的差异比较结果。
58例患者符合纳入标准。平均年龄为36.7岁（范围15 - 60岁），平均体重指数为28.9（范围18 - 42）。采用SP方法保存的OCA移植给12例患者，平均随访时间为（66.1个月；范围54 - 70个月）；采用MOPS方法保存的OCA移植给46例患者，平均随访时间为（44.8个月；范围24 - 60个月）。末次随访时，MOPS OCA的移植物存活率（98%）显著高于SP OCA（75%）（P = .025），而2年功能性移植物存活率（MOPS 98% vs SP 83%；P = .1）则无显著差异。SP组的再次手术率显著高于MOPS组（P = .0014）。使用MOPS移植物进行单极髌骨、单极滑车和双极髌股关节OCA移植后4年，PROMs显示出具有统计学意义和临床意义的改善。与单极滑车和双极髌股关节OCA相比，单极髌骨OCA移植在1年时疼痛减轻更显著，PROMs更好。
使用MOPS壳状移植物进行单极和双极髌股关节表面置换的OCA移植与术前疼痛和功能水平相比，在统计学上有显著改善且具有临床意义。SP组的2年功能性移植物存活率为83%，MOPS组为98%，因此在使用壳状移植物进行髌股关节损伤的OCA移植时，MOPS与SP方法相比具有更好的短期疗效。接受单极髌骨异体移植的患者在疼痛和功能方面报告的结果最佳。
III级，登记数据的回顾性分析。
