Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Musculoskeletal Radiology Section, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany.
Knee Surg Sports Traumatol Arthrosc. 2023 Jun;31(6):2166-2173. doi: 10.1007/s00167-022-07237-3. Epub 2022 Nov 17.
To evaluate long-term clinical and radiologic outcomes of patients undergoing autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and to perform a correlation analysis between clinical and radiologic outcomes.
Thirty-five patients with a mean age of 32.2 ± 8.9 years undergoing AOT for OLT between 1997 and 2003 were available for follow-up after an average of 19.1 ± 1.4 years. Demographic, surgical, and injury-related data were collected. After a minimum 18-year follow-up, patient-reported outcome scores (PROs) were collected, including the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Foot and Ankle Outcome Score (FAOS), Tegner Activity Scale, and Visual Analogue Scale (VAS) for pain of the ankle. The Lysholm Score and VAS for pain of the knee were collected to assess donor-site morbidity. Magnetic resonance imaging scans were obtained to conduct an assessment of the replaced cartilage using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scoring system. Any revision surgery (except symptomatic hardware removal and arthroscopic debridement) was defined as clinical failure.
Favorable clinical and radiologic (MOCART score, 73.7 ± 16.7 points) outcomes without any donor-site morbidities were observed. Twenty-three (65.7%) patients were satisfied or very satisfied with the surgical treatment. Fourteen (40.0%) and 25 (71.4%) patients had no or minor limitations in their athletic and working performance, respectively. A significant correlation between the MOCART and the FAOS Sport and Recreational activities subscale was found (r, 0.491; p = 0.033). Six (17.1%) patients met the criteria for clinical failure an average of 12.2 ± 6.6 years after AOT. Survival analysis demonstrated a mean estimated time of survival of 21.3 years (95% CI [19.55, 22.96]) and a 20-year survival rate of 77.9%.
Autologous osteochondral transplantation to treat OLT achieves high patient satisfaction and favorable PROs with a 20-year survival rate of almost 80%. Given the high clinical efficacy of AOT, this procedure can be recommended as a safe and promising technique for the long-term therapy of OLT.
Level IV.
评估自体软骨移植（AOT）治疗距骨骨软骨病变（OLT）患者的长期临床和影像学结果，并对临床和影像学结果进行相关性分析。
1997 年至 2003 年间，35 例平均年龄为 32.2±8.9 岁的患者接受 AOT 治疗 OLT，平均随访 19.1±1.4 年后可进行随访。收集患者的人口统计学、手术和损伤相关数据。在至少 18 年的随访后，收集患者报告的结果评分（PROs），包括美国矫形足踝协会（AOFAS）评分、足踝结局评分（FAOS）、Tegner 活动量表和踝关节疼痛的视觉模拟评分（VAS）。为评估供区发病率，收集了膝关节 Lysholm 评分和 VAS 疼痛评分。获得磁共振成像扫描，使用磁共振观察软骨修复组织（MOCART）2.0 评分系统评估置换软骨。任何翻修手术（除了有症状的内固定物取出和关节镜清理术）均定义为临床失败。
观察到良好的临床和影像学（MOCART 评分，73.7±16.7 分）结果，无供区并发症。23 例（65.7%）患者对手术治疗满意或非常满意。14 例（40.0%）和 25 例（71.4%）患者的运动和工作表现分别无或仅有轻微受限。MOCART 与 FAOS 运动和娱乐活动亚量表之间存在显著相关性（r，0.491；p=0.033）。6 例（17.1%）患者在 AOT 后平均 12.2±6.6 年达到临床失败标准。生存分析显示，平均估计生存率为 21.3 年（95%CI[19.55，22.96]），20 年生存率为 77.9%。
自体软骨移植治疗 OLT 可获得较高的患者满意度和良好的 PROs，20 年生存率接近 80%。鉴于 AOT 的高临床疗效，该手术可作为 OLT 长期治疗的一种安全、有前景的技术。
IV 级。
