目的：本系统评价的目的是评估特殊幼年软骨同种异体移植（PJCA）治疗距骨软骨损伤（OLT）后短期随访的临床和放射学结果以及并发症发生率和失败率。
方法：2023年10月，PubMed，系统审查了Embase和Cochrane库数据库，以确定检查PJCA后OLT管理结果的临床研究。有关研究特征的数据，患者人口统计学，病变特征,主观临床结果，放射学结果，提取并分析并发症和失败。
结果：纳入12项研究。总的来说,241例患者接受PJCA治疗OLT，加权平均随访29.0±24.9个月。加权平均病变大小为138.3±59.6mm2。先前的手术干预记录在七项研究中，其中最常见的是微骨折(65.9%).加权平均美国骨科足踝协会评分从术前58.5±3.2分提高到术后83.9±5.3分。术后磁共振观察软骨修复组织(MOCART)评分加权平均为48.2±3.3。并发症发生率为25.2%,其中最常见的是同种异体移植肥大(13.2%)。在指数程序之后，在9.8±9.6个月的加权平均时间内观察到30次失败（12.4％）。
结论：本系统评价显示，在短期随访中，PJCA治疗OLT后的主观临床结果有中度改善。然而,据报道,术后MOCART评分较差.此外,在短期随访中观察到高并发症率(25.2%)和高失败率(12.4%),质疑PJCA治疗大型OLT的疗效。根据现有的证据,目前不能推荐用于治疗大型OLT的PJCA。
方法：四级。
OBJECTIVE: The purpose of this systematic
review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates at short-term follow-up following particulated juvenile cartilage allograft (PJCA) for the management of osteochondral lesions of the talus (OLT).
METHODS: During October 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following PJCA for the management of OLTs. Data regarding study characteristics, patient demographics, lesion characteristics, subjective clinical outcomes, radiological outcomes, complications and failures were extracted and analysed.
RESULTS: Twelve studies were included. In total, 241 patients underwent PJCA for the treatment of OLT at a weighted mean follow-up of 29.0 ± 24.9 months. The weighted mean lesion size was 138.3 ± 59.6 mm2 . Prior surgical intervention was recorded in seven studies, the most common of which was microfracture (65.9%). The weighted mean American Orthopaedic Foot and Ankle Society score improved from a preoperative score of 58.5 ± 3.2 to a postoperative score of 83.9 ± 5.3. The weighted mean postoperative magnetic resonance observation of cartilage repair tissue (MOCART) score was 48.2 ± 3.3. The complication rate was 25.2%, the most common of which was allograft hypertrophy (13.2%). Thirty failures (12.4%) were observed at a weighted mean time of 9.8 ± 9.6 months following the index procedure.
CONCLUSIONS: This systematic
review demonstrated a moderate improvement in subjective clinical outcomes following PJCA for the treatment of OLT at short term follow-up. However, postoperative MOCART scores were reported as poor. In addition, a high complication rate (25.2%) and a high failure rate (12.4%) at short-term follow-up was observed, calling into question the efficacy of PJCA for the treatment of large OLTs. In light of the available evidence, PJCA for the treatment of large OLTs cannot be currently recommended.
METHODS: Level IV.
