背景:距骨软骨损伤(OCLT)是难以治疗的常见损伤。迄今为止,尚未比较有或没有自体跟骨移植的青少年同种异体软骨植入患者的长期患者报告结局指标(PROMs)。
方法:13例难以治疗的OCLTs患者接受关节镜辅助植入微粒少年同种异体移植软骨(DeNovoNT®),由一名外科医生进行或不进行自体跟骨移植。跟骨骨移植物的使用由病灶大小>150mm2和/或深度大于5mm确定。使用体检对患者进行评估,患者访谈,和PROMs。
结果:比较跟骨移植的患者,年龄没有差异,BMI,术前计划,或者注意到后续行动,然而,跟骨移植患者的病灶大小明显更大(188.5±50.9vs.分别为118.7±29.4mm2;p值=0.027)。最终随访改善期间的VAS和FAAMADL评分在队列之间没有显着差异。与骨移植组相比,DeNovo单独组的FAAM运动评分显着提高更多(p值=0.032)。队列之间的AOFAS评分改善没有差异(p值=0.944),然而,与骨移植组相比,单独使用DeNovo组的SF-36PCS明显改善(p值=0.038).跟骨植骨术中/围手术期无并发症发生。
结论:虽然患者在植入有/没有自体跟骨移植的幼年同种异体软骨(DeNovoNT®)后约8年的时间内随访,但术后PROMs阳性,无跟骨移植的患者在功能结局评分方面有显著改善.这些差异是由于移植物掺入还是较大的病变大小尚不清楚。
方法:III,回顾性队列研究。
BACKGROUND: Osteochondral lesions of the talus (OCLT) are common injuries that can be difficult to treat. To date, long-term patient reported outcome measures (PROMs) of patients with particulated juvenile allograft cartilage implantation with or without calcaneal autograft have not been compared.
METHODS: Thirteen patients with difficult to treat OCLTs underwent arthroscopic-assisted implantation of particulated juvenile allograft cartilage (DeNovo NT®) with or without autogenous calcaneal bone grafting by a single surgeon. Calcaneal bone graft use was determined by lesion size > 150 mm2 and/or deeper than 5 mm. Patients were evaluated using physical examination, patient interviews, and PROMs.
RESULTS: When comparing patients in regards to calcaneal bone graft implantation, no difference in age, BMI, pre-operative PROMs, or follow-up was noted, however, calcaneal bone graft patients did have a significantly larger lesion size (188.5 ± 50.9 vs. 118.7 ± 29.4 mm2 respectively; p value = 0.027). VAS and FAAM ADL scores during final follow-up improvement did not significantly differ between cohorts. The FAAM Sports score improved significantly more for the DeNovo alone group compared to the bone graft cohort (p value = 0.032). The AOFAS score improvement did not differ between cohorts (p value = 0.944), however, the SF-36 PCS improved significantly more for the DeNovo alone group compared to the bone graft cohort (p value = 0.038). No intraoperative/perioperative complications were observed with calcaneal bone grafting.
CONCLUSIONS: While patients followed over the course of ~ 8 years after implantation of particulated juvenile allograft cartilage (DeNovo NT®) with/without autogenous calcaneal bone graft had positive post-operative PROMs, patients without calcaneal bone graft had significantly greater improvement in functional outcome scores. Whether these differences are due to graft incorporation or larger lesion size is unclear.
METHODS: III, retrospective cohort study.