Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea.
Am J Sports Med. 2023 Jul;51(8):2120-2126. doi: 10.1177/03635465231173692. Epub 2023 Jun 1.
The effect of a concurrent cartilage procedure in lateral meniscal allograft transplantation (MAT) in patients with bipolar cartilage lesions (high-grade lesions on both the femoral and the tibial side) is not well studied. An objective evaluation of graft status after MAT and a concurrent cartilage procedure has not been reported.
To investigate the effect of concurrent cartilage procedures and lateral MAT on objective and clinical outcomes, including survival, in patients with bipolar cartilage lesions.
Cohort study; Level of evidence, 3.
A total of 149 patients with high-grade (International Cartilage Regeneration & Joint Preservation Society grade 3 or 4) cartilage lesions were enrolled and assigned to 1 of 3 groups based on the cartilage procedure and cartilage status at the time of MAT. Femoral cartilage procedures (microfracture, n = 18; osteochondral autograft transfer, n = 13) and lateral MAT were performed in 31 patients with bipolar cartilage lesions (cartilage procedure group). Another 70 patients with bipolar lesions underwent only lateral MAT without cartilage procedure (bipolar lesion group). The remaining 48 patients, who had high-grade lesions only on the tibial side and underwent lateral MAT without a cartilage procedure, were selected as a control group (unipolar lesion group). Anatomic survival was objectively assessed by follow-up magnetic resonance imaging and second-look arthroscopy. Clinical survivorship was determined with a Lysholm score <65 or need for additional surgery, such as revision MAT.
The mean Lysholm score improved from 67.2 ± 15.9 preoperatively to 86.7 ± 11.1 with a mean follow-up of 78.0 ± 51.2 months ( < .001). The postoperative scores were not significantly different between the 3 groups. The estimated 5-year anatomic survival rate in the cartilage procedure group (86.7%) was higher than that in the bipolar lesion group (65.0%; = .043) but comparable with that in the unipolar lesion group (90.2%; = .572). The estimated 5-year clinical survival rates were not significantly different between the groups ( = .187).
A concurrent femoral cartilage procedure improved the anatomic survival rate in patients with bipolar chondral lesions who underwent lateral MAT. This finding suggests that the cartilage procedure is an effective treatment choice and may improve the status of an allograft after lateral MAT for patients with bipolar cartilage lesions.
在双侧半月板骨软骨病变（股骨和胫骨侧均存在高级别病变）患者中进行外侧半月板同种异体移植（MAT）时同时进行软骨手术的效果尚未得到充分研究。目前尚未报道关于 MAT 后同时进行软骨手术对移植物状态的客观评估。
探讨在双侧半月板骨软骨病变患者中，同时进行软骨手术和外侧 MAT 对客观和临床结果（包括存活率）的影响。
队列研究；证据水平，3 级。
共纳入 149 例存在高级别（国际软骨修复与关节保存学会 3 级或 4 级）软骨病变的患者，根据 MAT 时的软骨手术和软骨状况将其分为 3 组。31 例双侧半月板骨软骨病变患者（软骨手术组）接受了股骨软骨手术（微骨折术，18 例；骨软骨自体移植术，13 例）和外侧 MAT。70 例双侧病变患者仅接受外侧 MAT 而未行软骨手术（双侧病变组）。另外 48 例胫骨侧仅存在高级别病变且未行软骨手术的患者被选为对照组（单侧病变组）。通过随访磁共振成像和二次关节镜检查客观评估解剖学存活率。临床存活率通过 Lysholm 评分<65 或需要进行额外手术（如翻修 MAT）来确定。
平均 Lysholm 评分从术前的 67.2±15.9 分提高到平均随访 78.0±51.2 个月时的 86.7±11.1 分（<0.001）。3 组间术后评分无显著差异。软骨手术组的 5 年解剖学存活率估计值（86.7%）高于双侧病变组（65.0%；=0.043），但与单侧病变组（90.2%；=0.572）相当。组间 5 年临床存活率无显著差异（=0.187）。
在接受外侧 MAT 的双侧半月板骨软骨病变患者中，同时进行股骨软骨手术可提高解剖学存活率。这一发现表明，软骨手术是一种有效的治疗选择，可能会改善双侧半月板骨软骨病变患者外侧 MAT 后同种异体移植物的状态。
