■近年来报道了令人满意的半月板同种异体移植(MAT)的临床结果。然而,目前尚不清楚MAT联合截骨术的临床结局是否低于孤立MAT.
比较接受孤立内侧MAT的患者与接受内侧MAT联合胫骨高位截骨术(HTO)的患者的生存率和临床结局。
■队列研究;证据水平,3.
■共有55名患者使用软组织技术和HTO(平均年龄,41.3±10.4岁;9名女性);在人口统计学上进行模糊病例对照匹配后,还包括55名接受孤立内侧MAT的对照。生存分析使用Kaplan-Meier方法进行手术失败,临床失败(Lysholm评分,<65),并作为端点重新操作。术前和最后随访时收集主观临床评分。
■平均随访时间为5.4年,长达8年。在最后一次随访中,所有结果均显着改善(P<.001)。术前和末次随访时,MAT组和MAT+HTO组之间无差异(P>0.05)。在最后的后续行动中,MAT+HTO患者的55人中有8人(14.5%)和MAT患者的55人中有9人(16.4%)的Lysholm评分<65(P=.885)。总的来说,90%的患者宣布他们将重复手术,而不管联合手术。110例患者中有6例(5.5%)出现手术失败:MAT+HTO组55例中有5例(9.1%),MAT组55例中有1例(1.8%)(P=0.093)。110例患者中有19例(17.3%)临床失败:MATHTO组55例中有11例(20%),MAT组55例中有8例(14.5%)(P=0.447)。在MAT+HTO组中,手术失败后的存活率显着降低(风险比,5.1;P=.049),而再次手术和临床失败的生存率没有差异(P>.05)。
接受内侧MAT+HTO的患者在中期随访时表现出与接受孤立内侧MAT的患者相似的临床结果,因此,手术解决的对准不良并不代表内侧MAT的禁忌症。然而,随着时间的推移,对伴随的HTO的需求与较高的故障率相关。
UNASSIGNED: Satisfactory clinical results of meniscal allograft transplantation (MAT) have been reported in recent years. However, it remains unclear whether the clinical outcomes of MAT when combined with an osteotomy are inferior to those of isolated MAT.
UNASSIGNED: To compare the survival rates and clinical outcomes of patients who received isolated medial MAT with those of patients undergoing medial MAT combined with high tibial osteotomy (HTO).
UNASSIGNED: Cohort study; Level of evidence, 3.
UNASSIGNED: A total of 55 patients underwent arthroscopic medial MAT using the soft tissue technique and HTO (mean age, 41.3 ± 10.4 years; 9 female); after fuzzy
case-control matching on demographics, 55 controls who underwent isolated medial MAT were also included. Survival analyses were performed using the Kaplan-Meier method with surgical failure, clinical failure (Lysholm score, <65), and reoperation as endpoints. Subjective clinical scores were collected preoperatively and at the final follow-up.
UNASSIGNED: The mean follow-up time was 5.4 years, up to 8 years. All outcomes significantly improved at the last follow-up (P < .001). No differences were identified between MAT and MAT + HTO groups preoperatively and at the last follow-up (P > .05). At the final follow-up, 8 of 55 (14.5%) of the MAT + HTO patients and 9 of 55 (16.4%) of the MAT patients had a Lysholm score <65 (P = .885). Overall, 90% of the patients declared they would repeat the surgery regardless of the combined procedure. Surgical failure was identified in 6 of 110 (5.5%) patients: 5 of 55 (9.1%) in the MAT + HTO group and 1 of 55 (1.8%) in the MAT group (P = .093). Clinical failure was identified in 19 of 110 (17.3%) patients: 11 of 55 (20%) in the MAT + HTO group and 8 of 55 (14.5%) in the MAT group (P = .447). A significantly lower survivorship from surgical failure was identified in the MAT + HTO group (hazard ratio, 5.1; P = .049), while no differences in survivorship from reoperation and clinical failure were identified (P > .05).
UNASSIGNED: Patients undergoing medial MAT + HTO showed similar clinical results to patients undergoing isolated medial MAT at midterm follow-up, and thus a surgically addressed malalignment does not represent a contraindication for medial MAT. However, the need for a concomitant HTO is associated with a slightly higher failure rate over time.