Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
Arthroscopy. 2024 Apr;40(4):1186-1194.e1. doi: 10.1016/j.arthro.2023.07.059. Epub 2023 Aug 18.
To report midterm outcomes after primary medial and lateral meniscal allograft transplantation (MAT) with fresh-frozen allografts implanted with the bridge-in-slot technique in the adolescent patient population.
Adolescent patients less than 18 years old at the time of primary MAT from 1999 to 2016 were retrospectively identified. International Knee Documentation Committee (IKDC) subjective form, Lysholm, and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales scores were collected before surgery and at 1-year, 2-year, and a minimum 5-year follow-up. Thresholds for achieving clinically significant outcomes were calculated, and the proportion of patients achieving minimal clinically important difference (MCID), patient-acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) was determined. Meniscus reoperation (partial, subtotal, or total meniscectomy, repair, or failure) and failure (revision MAT or conversion to arthroplasty) rates were determined.
Forty-four (female n = 33; male n = 11) of 62 identified patients met inclusion criteria and were followed for a mean of 9.5 ± 3.8 years (range, 5.0-17.7). Lateral MAT was performed in most patients (n = 35/44 [80%]). Isolated MAT was performed in 27 (61%) patients. Common concomitant procedures included osteochondral allograft transplantation (32%), autologous chondrocyte implantation (18%), and anterior cruciate ligament reconstruction (14%). MCID, PASS, and SCB were achieved by patients at a minimum 5-year follow-up for IKDC (62%; 76%; 31%), Lysholm (62%; 79%; 23%), and KOOS questionnaires (Pain [65%; 81%; 41%], Symptoms [58%; 81%; 47%], Activities of Daily Living [53%; 77%; 35%], Sport [86%; 75%; 50%], and Quality of Life [59%; 81%; 59%]), respectively. Fourteen patients (32%) underwent reoperation at an average of 5.0 ± 4.3 years (range, 0.8-14.0) after MAT. Three (7%) patients met criteria for failure, requiring revision MAT an average of 3.8 ± 1.1 years (range, 2.8-4.9) after transplantation. No patients underwent arthroplasty. Overall survival free from failure at 1, 2, 5, and 10 years was 100%, 100%, 93%, and 93%, respectively. At the time of final follow-up, 80% of patients reported satisfaction with their current physical status.
Primary MAT in adolescent patients resulted in significant and durable functional improvements at mid- to long-term follow-up. At an average of 9.5 years after surgery, meniscal reoperation rate was 32% whereas graft survival free of revision MAT was 93%. Adolescents undergoing MAT demonstrated similar functional outcomes and graft survivability when compared to available adult MAT literature.
Level IV, retrospective case series.
报告在青少年患者中使用桥接插槽技术植入新鲜冷冻同种异体移植物进行初次内侧和外侧半月板同种异体移植（MAT）的中期结果。
回顾性确定了 1999 年至 2016 年间初次 MAT 时年龄小于 18 岁的青少年患者。收集术前和 1 年、2 年和至少 5 年随访时的国际膝关节文献委员会（IKDC）主观评分、Lysholm 和膝关节损伤和骨关节炎结果评分（KOOS）子量表评分。计算达到临床显著结果的阈值，并确定达到最小临床重要差异（MCID）、患者可接受的症状状态（PASS）和实质性临床获益（SCB）的患者比例。确定半月板再手术（部分、次全或全半月板切除术、修复或失败）和失败（翻修 MAT 或转换为关节置换）的发生率。
在 62 名确定的患者中，有 44 名（女性 n=33；男性 n=11）符合纳入标准，并平均随访 9.5±3.8 年（范围，5.0-17.7）。大多数患者接受了外侧 MAT（n=35/44 [80%]）。27 名（61%）患者接受了单纯 MAT。常见的伴随手术包括骨软骨同种异体移植（32%）、自体软骨细胞移植（18%）和前交叉韧带重建（14%）。在至少 5 年的随访中，患者达到了 IKDC（62%；76%；31%）、Lysholm（62%；79%；23%）和 KOOS 问卷（疼痛[65%；81%；41%]）的 MCID、PASS 和 SCB，症状[58%；81%；47%]，日常生活活动[53%；77%；35%]，运动[86%；75%；50%]和生活质量[59%；81%；59%]）。14 名患者（32%）在 MAT 后平均 5.0±4.3 年（范围，0.8-14.0）时接受了再手术。3 名（7%）患者符合失败标准，需要在移植后平均 3.8±1.1 年（范围，2.8-4.9）进行翻修 MAT。没有患者接受关节置换。1 年、2 年、5 年和 10 年时无失败的总体生存率分别为 100%、100%、93%和 93%。在最后一次随访时，80%的患者报告对目前的身体状况满意。
青少年患者初次 MAT 可在中期至长期随访中获得显著且持久的功能改善。在手术后平均 9.5 年时，半月板再手术率为 32%，而无需翻修 MAT 的移植物存活率为 93%。接受 MAT 的青少年与现有成人 MAT 文献相比，具有相似的功能结果和移植物存活率。
IV 级，回顾性病例系列研究。
