股骨髁骨软骨异体移植同期半月板异体移植术后结局的前瞻性评估
Prospective Assessment of Outcomes After Femoral Condyle Osteochondral Allograft Transplantation With Concurrent Meniscus Allograft Transplantation.
作者信息
Richards Jarod A, Rucinski Kylee, Stannard James P, Nuelle Clayton W, Cook James L
机构信息
Mizzou Joint Preservation Center, Missouri Orthopaedic Institute, Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.
University of Louisville, Department of Orthopaedic Surgery, Louisville, Kentucky, USA.
出版信息
Orthop J Sports Med. 2024 Sep 19;12(9):23259671241256619. doi: 10.1177/23259671241256619. eCollection 2024 Sep.
BACKGROUND
Osteochondral allograft transplantation (OCAT) and meniscus allograft transplantation (MAT) have each become more commonly implemented for the treatment of young to middle-aged patients with complex knee pathology. Evidence regarding tibiofemoral OCAT in the setting of concurrent MAT is limited.
PURPOSE/HYPOTHESIS: The purpose of this study was to characterize outcomes for femoral condyle OCAT with concurrent MAT (OCAT+MAT) in the ipsilateral compartment of patients after evidence-based shifts in practice. It was hypothesized that OCAT+MAT would be associated with successful outcomes characterized by statistically significant and clinically meaningful improvements in patient-reported outcome measures (PROMs) of knee pain and function in >80% of patients for at least 2 years after transplantation.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
With institutional review board approval and documented informed consent, patients who underwent primary OCAT+MAT between 2016 and 2020 and enrolled in a lifelong registry for prospective collection of outcomes after OCAT were included. Patients with minimum 2-year follow-up data regarding complications, failures, adherence, and PROMs were analyzed. Patients who required OCAT and/or MAT revision or conversion to arthroplasty were defined as experiencing treatment failures.
RESULTS
A total of 23 consecutive patients (mean age, 37.1 years; mean body mass index, 28 kg/m; 14 men) met the inclusion criteria, with a mean follow-up of 51 months (range, 24-86 months). The initial treatment success rate was 78% based on 5 initial treatment failures, and the overall success rate was 83% based on a successful revision OCAT. All failures occurred in the medial compartment. Older patient age (42.2 vs 32.1 years; = .046) and nonadherence to postoperative restriction and rehabilitation protocols ( = .033; odds ratio, 14) were significant risk factors for treatment failure. All measured PROMs achieved significant improvements ( < .001) and minimum clinically important differences at a minimum of 2 years postoperatively.
CONCLUSION
OCAT+MAT was associated with successful short- to mid-term outcomes in 83% of cases. Evidence-based shifts in practice were implemented before the enrollment of this patient cohort. Older patients and those who were not adherent to postoperative restriction and rehabilitation protocols had a significantly higher risk for treatment failure and subsequent conversion to arthroplasty.
背景
骨软骨异体移植（OCAT）和半月板异体移植（MAT）在治疗年轻至中年复杂膝关节病变患者中均变得更为常用。关于在同时进行MAT的情况下进行胫股OCAT的证据有限。
目的/假设：本研究的目的是在基于循证实践转变后，描述同侧间室中股骨髁OCAT联合MAT（OCAT+MAT）患者的治疗结果。研究假设是，OCAT+MAT将与成功的治疗结果相关，其特征为在移植后至少2年，超过80%的患者在患者报告的膝关节疼痛和功能结局测量指标（PROMs）上有统计学显著且具有临床意义的改善。
研究设计
病例系列；证据等级，4级。
方法
经机构审查委员会批准并记录有知情同意书，纳入2016年至2020年间接受初次OCAT+MAT并纳入OCAT术后结局前瞻性收集的终身登记系统的患者。分析有至少2年随访数据的患者的并发症、失败情况、依从性和PROMs。需要进行OCAT和/或MAT翻修或转换为关节成形术的患者被定义为治疗失败。
结果
共有23例连续患者（平均年龄37.1岁；平均体重指数28kg/m；14例男性）符合纳入标准，平均随访51个月（范围24 - 86个月）。基于5例初次治疗失败，初次治疗成功率为78%，基于成功翻修的OCAT，总体成功率为83%。所有失败均发生在内侧间室。患者年龄较大（42.2岁对32.1岁；P = 0.046）以及不遵守术后限制和康复方案（P = 0.033；比值比，14）是治疗失败的显著危险因素。所有测量的PROMs在术后至少2年时均取得了显著改善（P < 0.001）且达到了最小临床重要差异。
结论
OCAT+MAT在83%的病例中与成功的短期至中期治疗结果相关。在该患者队列入组前实施了基于循证的实践转变。年龄较大的患者以及不遵守术后限制和康复方案的患者治疗失败及随后转换为关节成形术的风险显著更高。
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