■胶原半月板植入物(CMI)被认为是在先前的半月板切除术后减轻膝关节疼痛和改善膝关节功能的有效程序。然而,关于CMI后长期患者报告结局指标的现有知识有限.
■为了评估临床结果,重新操作,以及CMI在至少10年随访中的失败。
■案例系列;证据级别,4.
■对在单一机构接受CMI的连续患者进行资格筛选。本研究的纳入标准是(1)内侧或外侧CMI;(2)单独或联合前交叉韧带重建手术,膝关节截骨,或软骨治疗;和(3)随访10至15年。通过图表审查获得了人口统计学和手术细节。询问患者对手术是否满意,并用Lysholm评分进行评估,膝关节损伤和骨关节炎结果评分(KOOS),疼痛的视觉模拟量表,和Tegner在最后的随访中得分。因任何原因需要部分或全部拆除支架的情况(包括支架破损,感染,或因骨关节炎进展而进行的手术)被认为是手术失败。生存分析采用Kaplan-Meier曲线,根据患者可接受症状状态(PASS)分析临床评分。
■共有92名患者(平均年龄,分析中包括42.2年。在术前评估和最后一次随访之间,所有临床评分均有显着改善。Outerbridge等级≥3级的软骨病与总体上较低的临床评分相关。而从半月板切除术到CMI≥5年的时间确定了更多的静息疼痛,并降低了KOOS子量表中的生活质量。在接受单独手术和联合手术的患者之间,临床评分没有显着差异。在最后的后续行动中,Lysholm平均得分为76.3分.总的来说,12例(13%)被认为是手术失败。16名患者(17%)的Lysholm评分未达到PASS,共有28例(30%)被归类为临床失败。总的来说,19%(KOOS疼痛)和40%(KOOS症状)的患者未达到KOOS分量表的PASS。Outerbridge等级≥3级的软骨病与所有KOOS分量表中未达到PASS的较高风险相关。而年龄≥45岁的手术导致疼痛子量表未达到PASS的风险较低。在最后一次随访中,63%的患者仍参与体育活动,41%处于相同或更高水平。最后,80%的患者对手术感到满意。
■手术后长达10年,接受CMI的患者中约有70%报告了令人满意的临床结果,与术前评估相比,临床主观评分仍较高。总的来说,30%的病例被认为是临床失败,13%认为手术失败,17%不符合Lysholm评分的PASS。此外,半月板切除术的软骨状态和时间对结果有负面影响,而年龄≥45岁与较少的疼痛相关。接受单独CMI或联合手术的患者之间没有临床差异。
UNASSIGNED: Collagen meniscal implant (CMI) is considered an effective procedure for reducing knee pain and improving knee function after previous meniscectomy. Nevertheless, the current knowledge regarding long-term patient reported-outcome measures after CMI is limited.
UNASSIGNED: To evaluate clinical outcomes, reoperations, and failures of CMI at a minimum 10-year follow-up.
UNASSIGNED: Case series; Level of evidence, 4.
UNASSIGNED: Consecutive patients who underwent CMI at a single institution were screened for eligibility. Inclusion criteria for the present study were (1) medial or lateral CMI; (2) isolated or combined procedure with anterior cruciate ligament reconstruction, knee osteotomy, or cartilage treatment; and (3) follow-up between 10 and 15 years. Demographics and surgical details were obtained via chart review. Patients were asked if they were satisfied with the procedure and were evaluated with the Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale for pain, and Tegner score at the final follow-up. Cases requiring partial or total scaffold removal for any reason (including scaffold breakage, infection, or surgery for osteoarthritis progression) were considered surgical failure. Survival analysis was performed with Kaplan-Meier curve, and clinical scores were analyzed based on the Patient Acceptable Symptom State (PASS).
UNASSIGNED: A total of 92 patients (mean age, 42.2 years were included in the analysis. A significant improvement in all clinical scores was reported between the preoperative evaluation and the last follow-up. A chondropathy with Outerbridge grade ≥3 was associated with significantly overall lower clinical scores, while a timing from meniscectomy to CMI of ≥5 years determined more pain at rest and reduced Quality of Life in the KOOS subscale. No significant difference was found in terms of clinical scores between patients undergoing isolated and combined procedures. At the final follow-up, the mean Lysholm score was 76.3 points. In total, 12 cases (13%) were considered surgical failures. Sixteen patients (17%) did not reach PASS for the Lysholm score, with a total of 28 cases (30%) classified as clinical failures. Overall, 19% (KOOS Pain) and 40% (KOOS Symptoms) of patients did not achieve the PASS in the KOOS subscales. Chondropathy with Outerbridge grade ≥3 was associated with a higher risk of not achieving the PASS in all the KOOS subscales, while age at surgery of ≥45 years resulted in a lower risk of not achieving PASS in the Pain subscale. At the last follow-up, 63% of patients were still involved in sports activity, with 41% at the same or higher level. Finally, 80% of the patients were satisfied with the procedure.
UNASSIGNED: Up to 10 years after surgery, around 70% of the patients who underwent CMI reported satisfactory clinical results, with clinical subjective scores still higher compared with the preoperative evaluation. Overall, 30% of cases were considered clinical failures, with 13% considered surgical failures and 17% not meeting the PASS for the Lysholm score. In addition, cartilage status and time from meniscectomy were shown to have a negative impact on the outcomes, while an age ≥45 years was associated with less pain. There was no clinical difference between patients who underwent isolated CMI or combined procedures.