Manzi Joseph E, Manchanda Kshitij, Nasra Matthew H, Sudah Suleiman Y, Coladonato Carlo, Quan Theodore, Wishman Mark, Moran Jay, Murray Daniel P, Chapman Cary B
Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA.
Weill Cornell Medicine, New York, NY, USA.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):561-568. doi: 10.1007/s00590-023-03642-7. Epub 2023 Aug 31.
Osteochondral lesions of the talus (OCLT) are common injuries that can be difficult to treat. To date, long-term patient reported outcome measures (PROMs) of patients with particulated juvenile allograft cartilage implantation with or without calcaneal autograft have not been compared.
Thirteen patients with difficult to treat OCLTs underwent arthroscopic-assisted implantation of particulated juvenile allograft cartilage (DeNovo NT®) with or without autogenous calcaneal bone grafting by a single surgeon. Calcaneal bone graft use was determined by lesion size > 150 mm and/or deeper than 5 mm. Patients were evaluated using physical examination, patient interviews, and PROMs.
When comparing patients in regards to calcaneal bone graft implantation, no difference in age, BMI, pre-operative PROMs, or follow-up was noted, however, calcaneal bone graft patients did have a significantly larger lesion size (188.5 ± 50.9 vs. 118.7 ± 29.4 mm respectively; p value = 0.027). VAS and FAAM ADL scores during final follow-up improvement did not significantly differ between cohorts. The FAAM Sports score improved significantly more for the DeNovo alone group compared to the bone graft cohort (p value = 0.032). The AOFAS score improvement did not differ between cohorts (p value = 0.944), however, the SF-36 PCS improved significantly more for the DeNovo alone group compared to the bone graft cohort (p value = 0.038). No intraoperative/perioperative complications were observed with calcaneal bone grafting.
While patients followed over the course of ~ 8 years after implantation of particulated juvenile allograft cartilage (DeNovo NT®) with/without autogenous calcaneal bone graft had positive post-operative PROMs, patients without calcaneal bone graft had significantly greater improvement in functional outcome scores. Whether these differences are due to graft incorporation or larger lesion size is unclear.
III, retrospective cohort study.
距骨骨软骨损伤（OCLT）是常见损伤，治疗可能存在困难。迄今为止，尚未对接受颗粒状青少年同种异体软骨植入且有或无自体跟骨移植患者的长期患者报告结局指标（PROMs）进行比较。
13例难以治疗的OCLT患者在关节镜辅助下接受了颗粒状青少年同种异体软骨（DeNovo NT®）植入，手术由同一位外科医生进行，部分患者同时进行了自体跟骨植骨。根据损伤大小>150 mm和/或深度超过5 mm来决定是否使用跟骨植骨。通过体格检查、患者访谈和PROMs对患者进行评估。
比较接受跟骨植骨的患者时，在年龄、体重指数、术前PROMs或随访方面未发现差异，然而，接受跟骨植骨的患者损伤尺寸明显更大（分别为188.5±50.9和118.7±29.4 mm；p值=0.027）。最终随访时，两组间VAS和FAAM ADL评分改善情况无显著差异。与植骨组相比，单纯使用DeNovo组的FAAM运动评分改善更显著（p值=0.032）。两组间AOFAS评分改善情况无差异（p值=0.944），然而，与植骨组相比，单纯使用DeNovo组的SF-36 PCS改善更显著（p值=0.038）。跟骨植骨未观察到术中/围手术期并发症。
虽然在植入颗粒状青少年同种异体软骨（DeNovo NT®）且有或无自体跟骨植骨后随访约8年的患者术后PROMs呈阳性，但未接受跟骨植骨的患者功能结局评分改善更显著。这些差异是由于移植物整合还是损伤尺寸较大尚不清楚。
III级，回顾性队列研究。
