Cook James L, Rucinski Kylee, Crecelius Cory R, Nuelle Clayton W, Stannard James P
Missouri Orthopaedic Institute, Joint Preservation Center, University of Missouri - Department of Orthopaedic Surgery, Columbia, MO, USA.
Thompson Laboratory for Regenerative Orthopaedics, University of Missouri - Department of Orthopaedic Surgery, Columbia, MO, USA.
J Orthop. 2025 Mar 17;70:88-94. doi: 10.1016/j.jor.2025.03.040. eCollection 2025 Dec.
Knee osteochondral allograft transplantation (OCAT) is consistently successful, however, higher failure rates for multisurface and bipolar OCATs persist. Failure mechanisms have involved OCA erosion, delamination, degeneration, fracture, and/or fragmentation, and progression of joint disease, associated with older patient age, higher BMI, male sex, nicotine use, comorbidities, low chondrocyte viability, larger OCA volume, and bipolar OCAT.
Patient outcomes were prospectively followed after primary knee OCAT and analyzed for failure mechanisms categorized as OCA Cartilage, OCA Bone, Meniscus Allograft, Joint Disease Progression, or Unknown. Cases were included when OCAT was performed >5 years prior; all failure cases were included regardless of final follow-up (FFU) time. Failure and non-failure cohorts, and failure mechanism subcohorts, were compared based on patient sex, age, BMI, nicotine use, concurrent procedures, OCAT surgery type, and adherence.
There were 186 cases in 184 patients (n = 112 males; mean age = 37.1 years; mean BMI = 28.5 kg/m; mean FFU = 79 months). Initial failure rate was 23.1% (n = 43) with mechanisms attributed to OCA Bone (n = 15; 34.9%), Meniscus (n = 13; 30.2%), Joint Disease Progress (n = 11; 25.6%), OCA Cartilage (n = 2; 4.7%), or Unknown (n = 2; 4.7%). Risk factors included concurrent ligament reconstruction, ipsilateral osteotomy, and tibiofemoral bipolar + OCAT. However, older age and higher BMI, as well as potential barriers for post-operative adherence should be considered during patient selection.
Recent advances have mitigated key risk factors, such that reductions in knee OCAT failure rates with improvements in function, mental health, and quality of life have been more consistently realized.
2, prospective cohort study.
膝关节同种异体骨软骨移植术（OCAT）一直很成功，然而，多表面和双极OCAT的失败率仍然较高。失败机制包括骨软骨异体移植（OCA）侵蚀、分层、退变、骨折和/或碎裂，以及关节疾病进展，这与患者年龄较大、体重指数（BMI）较高、男性、吸烟、合并症、软骨细胞活力低、OCA体积较大和双极OCAT有关。
对初次膝关节OCAT后的患者预后进行前瞻性随访，并分析失败机制，分为OCA软骨、OCA骨、半月板同种异体移植、关节疾病进展或不明原因。当OCAT手术在5年多以前进行时纳入病例；所有失败病例均纳入，无论最终随访（FFU）时间如何。根据患者性别、年龄、BMI、吸烟情况、同期手术、OCAT手术类型和依从性，比较失败和未失败队列以及失败机制亚组。
184例患者中有186例（n = 112例男性；平均年龄 = 37.1岁；平均BMI = 28.5 kg/m²；平均FFU = 79个月）。初始失败率为23.1%（n = 43），失败机制归因于OCA骨（n = 15；34.9%）、半月板（n = 13；30.2%）、关节疾病进展（n = 11；25.6%）、OCA软骨（n = 2；4.7%）或不明原因（n = 2；4.7%）。危险因素包括同期韧带重建、同侧截骨术以及胫股双极 + OCAT。然而，在患者选择过程中应考虑年龄较大和BMI较高，以及术后依从性的潜在障碍。
最近的进展已经减轻了关键危险因素，从而更持续地实现了膝关节OCAT失败率的降低以及功能、心理健康和生活质量的改善。
2，前瞻性队列研究。
