Bouz Tony S, Wang Tim, Penn Jordan K, McCauley Julie C, Bugbee William D
Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA.
Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, California, USA.
Am J Sports Med. 2025 Mar;53(4):855-862. doi: 10.1177/03635465241313139. Epub 2025 Jan 28.
Fresh osteochondral allograft (OCA) transplantation is an established treatment option for patients with chondral or osteochondral lesions of the knee. Predictably positive outcomes are seen in situations of focal or isolated cartilage defects. However, OCA transplantation may also be performed in more complex joint salvage situations in young patients.
To evaluate survivorship and outcomes in patients who underwent OCA transplantation for large bipolar lesions of the knee.
Case series; Level of evidence, 4.
Fresh OCAs were implanted for bipolar chondral lesions in 86 patients (89 knees) between 1983 and 2020. A total of 37 male and 52 female knees with a mean patient age of 37.9 years (range, 14.5-66.0 years) were treated. Surgical indications included degenerative chondral lesions, osteoarthritis, osteochondritis dissecans, traumatic chondral injuries, and previous failed OCAs. The clinical evaluation included the modified Merle d'Aubigné-Postel score, International Knee Documentation Committee (IKDC) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Outcomes were collected during outpatient clinic visits or via mail. The minimum follow-up was 2 years. Additional procedures after OCA transplantation were documented. OCA failure was defined as a reoperation that involved removal of the allograft.
There were 81 knees (91.0%) that had undergone previous surgery, with a mean of 3.2 previous procedures (range, 1-11). The mean treated defect surface area was 16.7 cm. Graft failure occurred in 31 knees (34.8%). Reoperations (including failures) occurred in 46 knees (51.7%). The mean time to failure was 4.8 years. Survivorship of the bipolar OCA was 73.8% at 5 years, 66.6% at 10 years, and 58.9% at 15 years. Among the 58 knees (65.2%) in which the OCA was still in situ, the mean follow-up was 11.3 years (range, 2.1-27.6 years). The mean modified Merle d'Aubigné-Postel score improved from 12.4 to 14.8 points; 64.3% of knees (36/56 with available data) were considered successful with a score ≥15. The mean IKDC pain score improved from 6.3 to 4.0, and the mean IKDC function score improved from 2.9 to 6.2. The KOOS symptoms, pain, activities of daily living, sports/recreation, and quality of life subscores all increased postoperatively by a mean of 19.7, 25.9, 27.1, 35.4, and 36.4, respectively.
OCA transplantation is a salvage treatment option for large bipolar cartilage lesions of the knee with acceptable survivorship and significant clinical improvement in a challenging patient population.
新鲜骨软骨异体移植（OCA）是治疗膝关节软骨或骨软骨损伤患者的一种既定治疗选择。在局灶性或孤立性软骨缺损的情况下可预见会有积极的结果。然而，OCA移植也可在年轻患者更复杂的关节挽救情况下进行。
评估因膝关节大双极病变接受OCA移植患者的移植存活率和预后。
病例系列；证据等级，4级。
1983年至2020年期间，对86例患者（89个膝关节）的双极软骨损伤植入新鲜OCA。共治疗了37个男性膝关节和52个女性膝关节，患者平均年龄为37.9岁（范围14.5 - 66.0岁）。手术指征包括退行性软骨损伤、骨关节炎、剥脱性骨软骨炎、创伤性软骨损伤以及先前OCA移植失败。临床评估包括改良Merle d'Aubigné - Postel评分、国际膝关节文献委员会（IKDC）评分和膝关节损伤与骨关节炎转归评分（KOOS）。在门诊就诊时或通过邮件收集预后数据。最短随访时间为2年。记录OCA移植后的其他手术。OCA失败定义为涉及移除异体移植物的再次手术。
81个膝关节（91.0%）曾接受过手术，平均先前手术次数为3.2次（范围1 - 11次）。平均治疗缺损表面积为16.7平方厘米。31个膝关节（34.8%）发生移植物失败。46个膝关节（51.7%）进行了再次手术（包括失败病例）。失败的平均时间为4.8年。双极OCA在5年时的移植存活率为73.8%，10年时为66.6%，15年时为58.9%。在OCA仍在位的58个膝关节（65.2%）中，平均随访时间为11.3年（范围2.1 - 27.6年）。改良Merle d'Aubigné - Postel评分平均从12.4分提高到14.8分；64.3%的膝关节（有可用数据的56个膝关节中的36个）评分≥15分被认为治疗成功。IKDC疼痛评分平均从6.3分提高到4.0分，IKDC功能评分平均从2.9分提高到6.2分。KOOS症状、疼痛、日常生活活动、运动/娱乐和生活质量子评分术后分别平均提高了19.7、25.9、27.1、35.4和36.4。
OCA移植是治疗膝关节大双极软骨损伤的一种挽救性治疗选择，在具有挑战性的患者群体中具有可接受的移植存活率和显著的临床改善。
