期刊
AMERICAN JOURNAL OF SPORTS MEDICINE
卷 44, 期 8, 页码 2015-2022出版社
SAGE PUBLICATIONS INC
DOI: 10.1177/0363546516645086
关键词
cartilage; osteochondral allograft; osteochondral defect; osteochondral transplantation
资金
- Advanced Bio-surfaces
- Arthrex Inc
- Arthrocare
- BioRegeneration Technologies
- Ceterix Orthopaedics
- DePuy
- Genzyme
- Knee Creations LLC
- MedShape Inc
- Mitek
- Moximed Inc
- NuOrtho Surgical Inc
- NuTech Medical
- Osiris Therapeutics Inc
- RTI Biologics Inc
- Schwartz Biomedical LLC
- Science and Biomaterials Inc
- Springer
- Stryker
- Thieme Medical Publishers Inc
- ZimmerBiomet
- Science for Biomaterials (SBM)
Background: Widespread adoption of fresh allograft transplantation remains limited, predominantly by supply issues. To overcome these limitations, a preshaped, cylindrical sterilized and decellularized osteochondral allograft (SDOCA) implant was recently introduced as a clinical treatment option. Purpose: To evaluate functional outcomes and graft survivorship among patients treated with the SDOCA implant for knee cartilage injuries. Study Design: Case series; Level of evidence, 4. Methods: An institutional review board-approved database was used to identify a series of patients with prospectively collected data who had been treated with the SDOCA implant. The surgeries were performed at 2 centers by 2 surgeons. Patient-reported outcomes, magnetic resonance imaging (MRI), and the number and type of reoperations were assessed. Failure was defined as structural damage of the graft diagnosed by arthroscopy or MRI, and any reoperation resulting in removal of the allograft. Patients were evaluated pre- and postoperatively using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Marx Sports Activity Scale. MRI was assessed preoperatively and postoperatively. Results: There were 32 patients with a mean age (SD) of 35.1 +/- 10.6 years; 59% were male. Twenty-three (72%) knees had previous surgery. The mean defect area (+/- SD) was 2.9 +/- 2.0 cm(2), and the mean allograft size was 13.18 +/- 2.3 mm (6 grafts 9 mm and 59 grafts 11 mm). The median number of allografts per knee was 2 (range, 1-5 grafts). Twenty-three of the 32 knees (72%) were considered failures by the definition detailed above. Of these, 14 knees (43%) had further surgery after the index procedure. Implant survivorship was 19.6% at 2 years. The mean follow-up duration was 1.29 years (range, 0.11-2.8 years). KOOS pain, activities of daily living (ADL), sports and recreation (sport/rec), and knee-related quality of life improved significantly from the preoperative visit to latest follow-up. Age was significantly predictive of failure, with a hazard ratio of 1.68 per 1 SD older (95% CI, 1.05-2.68; P = .030). The MOCART (magnetic resonance observation of cartilage repair tissue) feature effusion was the only score to correlate with KOOS (symptoms, pain, ADL, sport/rec). Conclusion: The SDOCA implant demonstrated a 72% failure rate within the first 2 years of implantation at these 2 institutions.
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