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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Efficacy of Fresh Osteochondral Allograft Transplantation in the Knee for Adults 40 Years and Older
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Efficacy of Fresh Osteochondral Allograft Transplantation in the Knee for Adults 40 Years and Older

机译：40岁及以上成年人新鲜骨软骨移植的功效

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Background: Osteochondral allograft (OCA) transplantation has become a standard therapy for cartilage restoration in young patients. Purpose: To determine the efficacy of fresh OCA transplantation for focal cartilage lesions in patients aged ≥40 years compared with a group of patients aged ≤39 years. Study Design: Cohort study; Level of evidence, 3. Methods: A database was used to identify patients who underwent fresh OCA transplantation in the knee in a single-surgeon practice over a 10-year period and who completed baseline patient-reported outcome (PRO) questionnaires, including the International Knee Documentation Committee (IKDC); Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of Pain, Symptoms, Activities of Daily Living, Quality of Life (QOL), and Sports & Recreation; and Veterans RAND 12-Item Health Survey (VR-12). Patients who completed the same PRO measures at a minimum 12-month follow-up were categorized into 2 groups based on age at surgery and were observed longitudinally. Mixed-model regression was used to predict longitudinal growth curves for each PRO score while controlling for confounding patient and surgical variables. Results: The study group consisted of 38 patients with a mean age of 52.32 years (range, 40-69 years) and mean final follow-up of 44.47 ± 24.32 months. The control group consisted of 42 patients with a mean age of 27.19 years (range, 15-39 years) and mean final follow-up of 33.75 ± 19.53 months. A statistically significant improvement from baseline to final follow-up was seen for the IKDC score and all 5 KOOS subscores in both the study and the control groups ( P & .01 in 10 of 12 comparisons and P & .05 for the other 2 comparisons). Maximum improvements were seen in the KOOS QOL and Sports & Recreation subscores for both groups. There was no statistically significant difference between groups in the change from baseline to final follow-up or in differences at any time point in model-based longitudinal projections for any PRO score through 5 years. Conclusion: There was a significant improvement of outcomes for both groups, with no statistically significant difference between groups over longitudinal follow-up. The efficacy of fresh OCA transplantation in adults aged ≥40 years with a focal chondral lesion and without osteoarthritis is similar to that of younger adults, and benefits are greatest for the KOOS QOL and Sports & Recreation subscales, which reflect functional outcomes.
机译：背景：骨软骨移植（OCA）已成为年轻患者软骨修复的标准疗法。目的：确定与年龄≤39岁的一组患者相比，新鲜OCA移植对≥40岁的患者局灶性软骨病变的疗效。研究设计：队列研究;证据等级，3。方法：使用数据库来识别在10年内通过一次外科医生实践在膝盖中进行新鲜OCA移植并完成基线患者报告结局（PRO）问卷的患者，包括国际膝关节文献委员会（IKDC）;疼痛，症状，日常生活活动，生活质量（QOL）以及运动与休闲的膝关节损伤和骨关节炎成果评分（KOOS）量表;和退伍军人RAND 12项健康调查（VR-12）。在至少12个月的随访中完成相同PRO措施的患者根据手术年龄分为两组，并进行纵向观察。混合模型回归用于预测每个PRO评分的纵向增长曲线，同时控制混杂的患者和手术变量。结果：研究组由38例患者组成，平均年龄为52.32岁（范围40-69岁），平均最终随访时间为44.47±24.32个月。对照组由42例患者组成，平均年龄为27.19岁（范围15-39岁），平均最终随访时间为33.75±19.53个月。在研究组和对照组中，IKDC评分和所有5个KOOS分数从基线到最终随访均具有统计学上的显着改善（12个比较中的10个中P <0.01，其他比较中的P <.05） 2个比较）。两组的KOOS QOL和“运动与娱乐”子评分均显示出最大的改进。从基线到最终随访的变化，或在任何时间点上，基于模型的纵向预测中任何时间点（直至5年）的变化在两组之间均无统计学意义。结论：两组的结局均有显着改善，纵向随访后两组间无统计学差异。新鲜OCA移植在≥40岁有局灶性软骨病变且无骨关节炎的成年人中的疗效与年轻成年人相似，并且对KOOS QOL和“运动与休闲”量表的益处最大，这反映了功能结局。

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