Wang Xueding, Ren Zhiyuan, Liu Yang, Ma Yongsheng, Huang Lingan, Song Wenjie, Lin Qitai, Zhang Zhipeng, Li Pengcui, Wei Xiaochun, Duan Wangping
Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China.
Orthop J Sports Med. 2023 Sep 21;11(9):23259671231199418. doi: 10.1177/23259671231199418. eCollection 2023 Sep.
Osteochondral allograft transplantation (OCA) treats symptomatic focal cartilage defects with satisfactory clinical results.
To comprehensively analyze the characteristics and clinical outcomes of OCA for treating articular cartilage defects.
Systematic review; Level of evidence, 4.
We searched Embase, PubMed, Cochrane Database, and Web of Science for studies published between January 1, 2001, and December 31, 2020, on OCA for treating articular cartilage defects. Publication information, patient data, osteochondral allograft storage details, and clinical outcomes were extracted to conduct a comprehensive summative analysis.
In total, 105 studies involving 5952 patients were included. The annual reported number of patients treated with OCA increased from 69 in 2001 to 1065 in 2020, peaking at 1504 cases in 2018. Most studies (90.1%) were performed in the United States. The mean age at surgery was 34.2 years, and 60.8% of patients were male and had a mean body mass index of 26.7 kg/m. The mean lesion area was 5.05 cm, the mean follow-up duration was 54.39 months, the mean graft size was 6.85 cm, and the number of grafts per patient was 54.7. The failure rate after OCA was 18.8%, and 83.1% of patients reported satisfactory results. Allograft survival rates at 2, 5, 10, 15, 20, and 25 years were 94%, 87.9%, 80%, 73%, 55%, and 59.4%, respectively. OCA was mainly performed on the knee (88.9%). The most common diagnosis in the knee was osteochondritis dissecans (37.9%), and the most common defect location was the medial femoral condyle (52%). The most common concomitant procedures were high tibial osteotomy (28.4%) and meniscal allograft transplantation (24.7%). After OCA failure, 54.7% of patients underwent revision with primary total knee arthroplasty.
The annual reported number of patients who underwent OCA showed a significant upward trend, especially from 2016 to 2020. Patients receiving OCA were predominantly young male adults with a high body mass index. OCA was more established for knee cartilage than an injury at other sites, and its best indication was osteochondritis dissecans. This analysis demonstrated satisfactory long-term postoperative outcomes.
骨软骨异体移植术（OCA）用于治疗有症状的局限性软骨缺损，临床效果良好。
全面分析骨软骨异体移植术治疗关节软骨缺损的特点及临床疗效。
系统评价；证据等级，4级。
检索Embase、PubMed、Cochrane数据库和Web of Science，查找2001年1月1日至2020年12月31日期间关于骨软骨异体移植术治疗关节软骨缺损的研究。提取发表信息、患者数据、骨软骨异体移植物储存细节及临床疗效，进行全面的总结性分析。
共纳入105项研究，涉及5952例患者。报告的每年接受骨软骨异体移植术治疗的患者数量从2001年的69例增加到2020年的1065例，2018年达到峰值1504例。大多数研究（90.1%）在美国进行。手术时的平均年龄为34.2岁，60.8%的患者为男性，平均体重指数为26.7kg/m。平均病变面积为5.05cm，平均随访时间为54.39个月，平均移植物大小为6.85cm，每位患者的移植物数量为54.7个。骨软骨异体移植术后的失败率为18.8%，83.1%的患者报告结果满意。异体移植物在2年、5年、10年、15年、20年和25年时的生存率分别为94%、87.9%、80%、73%、55%和59.4%。骨软骨异体移植术主要在膝关节进行（88.9%）。膝关节最常见的诊断是剥脱性骨软骨炎（37.9%），最常见的缺损部位是股骨内侧髁（52%）。最常见的同期手术是高位胫骨截骨术（28.4%）和半月板异体移植术（24.7%）。骨软骨异体移植术失败后，54.7%的患者接受了初次全膝关节置换翻修手术。
报告的每年接受骨软骨异体移植术治疗的患者数量呈显著上升趋势，尤其是在2016年至2020年期间。接受骨软骨异体移植术的患者主要是体重指数较高的年轻男性成年人。骨软骨异体移植术在膝关节软骨损伤的治疗中比在其他部位的损伤中应用更为成熟，其最佳适应证是剥脱性骨软骨炎。该分析显示了令人满意的长期术后疗效。
