Cook James L, Stannard James P, Stoker Aaron M, Rucinski Kylee, Crist Brett D, Cook Cristi R, Crecelius Cory, Bozynski Chantelle C, Kuroki Keiichi, Royse Lisa A, Stucky Renee, Hung Clark T, Smith Matthew J, Schweser Kyle M, Nuelle Clayton W, DeFroda Steven
Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.
Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.
J Knee Surg. 2025 Apr;38(5):256-271. doi: 10.1055/a-2506-2675. Epub 2024 Dec 19.
More than 70 million adults in the United States are impacted by osteoarthritis (OA). Symptomatic articular cartilage loss that progresses to debilitating OA is being diagnosed more frequently and earlier in life, such that a growing number of active patients are faced with life-altering health care decisions at increasingly younger ages. Joint replacement surgeries, in the form of various artificial arthroplasties, are reliable operations, especially for older (≥65 years), more sedentary patients with end-stage OA, but have major limitations for younger, more active patients. For younger adults and those who wish to remain highly active, artificial arthroplasties are associated with significantly higher levels of pain, complications, morbidity, dysfunction, and likelihood of revision. Unfortunately, non-surgical management strategies and surgical treatment options other than joint replacement are often not indicated and have not proven to be consistently successful for this large and growing population of patients. As such, these patients are often relegated to postpone surgery, take medications including opioids, profoundly alter their lifestyle, and live with pain and disability until artificial arthroplasty is more likely to meet their functional demands without high risk for early revision. As such, our research team set out to develop, test, and validate biologic joint restoration strategies that could provide consistently successful options for young and active patients with joint disorders who were not considered ideal candidates for artificial arthroplasty. In pursuit of this goal, we implemented a targeted bedside-to-bench-to-bedside translational approach to hypothesis-driven studies designed to address this major unmet need in orthopaedics by identifying and overcoming key clinical limitations and obstacles faced by health care teams and patients in realizing optimal outcomes after biologic joint restoration. The objective of this article is to condense more than two decades of rigorous patient-centered research aimed at optimizing osteochondral and meniscus allograft transplantation toward more consistently successful management of complex joint problems in young and active patients.
美国有超过7000万成年人受到骨关节炎（OA）的影响。有症状的关节软骨损失进展为使人衰弱的OA，这种情况在生活中被诊断得越来越频繁且越来越早，以至于越来越多活跃的患者在越来越年轻的时候就面临改变生活的医疗保健决策。以各种人工关节成形术形式进行的关节置换手术是可靠的手术，特别是对于年龄较大（≥65岁）、活动较少的终末期OA患者，但对于年轻、更活跃的患者有很大局限性。对于年轻成年人以及那些希望保持高度活跃的人来说，人工关节成形术会带来明显更高程度的疼痛、并发症、发病率、功能障碍以及翻修可能性。不幸的是，除关节置换外的非手术管理策略和手术治疗选择通常并不适用，而且对于这一庞大且不断增加的患者群体而言，尚未证明能始终取得成功。因此，这些患者常常不得不推迟手术、服用包括阿片类药物在内的药物、大幅改变生活方式，并忍受疼痛和残疾，直到人工关节成形术更有可能满足他们的功能需求且早期翻修风险较低。因此，我们的研究团队着手开发、测试和验证生物关节修复策略，这些策略可为不被认为是人工关节成形术理想候选者的年轻活跃关节疾病患者提供始终成功的选择。为了实现这一目标，我们对假设驱动的研究采用了有针对性的从床边到实验台再到床边的转化方法，旨在通过识别和克服医疗团队及患者在生物关节修复后实现最佳结果时面临的关键临床局限性和障碍，来解决骨科这一主要未满足的需求。本文的目的是浓缩二十多年来以患者为中心的严谨研究，旨在优化骨软骨和半月板同种异体移植，以更始终如一地成功治疗年轻活跃患者的复杂关节问题。
