Background:Fresh osteochondral allograft (OCA) transplantation is an effective technique for the treatment of focal chondral and osteochondral defects in the knee. Coronal-plane malalignment leads to increased contact forces within a compartment and subsequently the cartilage repair site and may lead to higher failure rates. However, the magnitude of the effect of coronal-plane malalignment on graft survivorship and clinical outcomes has not been well characterized.Purpose:To evaluate how varus malalignment affects graft survival and patient-reported outcomes after isolated OCA transplantation of the medial femoral condyle (MFC).Study Design:Cohort study; Level of evidence, 3.Methods:A total of 70 patients (74 knees) who underwent primary OCA transplantation of the MFC between 2005 and 2019 were identified from a prospectively collected single-surgeon cartilage registry with a minimum 2-year follow-up. Coronal-plane alignment was evaluated utilizing standing hip-to-ankle radiographs. OCA failure, defined as removal of the graft or conversion to arthroplasty, and reoperations were recorded. Patient-reported outcomes were obtained preoperatively and postoperatively using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, modified Merle d’Aubigné–Postel score, and overall patient satisfaction score.Results:The mean mechanical tibiofemoral angle for patients with varus alignment was 3.9° of varus (range, 1.1° to 8.9°) and for patients with nonvarus alignment it was 0.02° of valgus (range, 3.6° varus to 4.6° valgus). Graft survivorship was 95.3% in the varus group and 95.8% in the nonvarus group ( P = .918) at 5 years postoperatively. Reoperations after OCA transplantation occurred in 14.0% of the varus group and 22.6% of the nonvarus group ( P = .336). The mean International Knee Documentation Committee total score improved from 45.2 preoperatively to 74.8 at latest follow-up in the varus group and from 40.5 preoperatively to 72.3 at latest follow-up in the nonvarus group. Patient satisfaction was >85%.Conclusion:Patients undergoing isolated OCA transplantation of the MFC had high rates (>90%) of graft survivorship and significant improvements in pain and function. Patients with mild preexisting varus malalignment were found to have no difference in the failure rate or clinical outcomes compared with patients with nonvarus alignment.

中文翻译：

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内翻和非内翻对齐患者股骨内侧髁同种异体骨软骨移植后的结局


背景： 新鲜同种异体骨软骨移植物 （OCA） 移植是治疗膝关节局灶性软骨和骨软骨缺损的有效技术。冠状面错位会导致隔室内的接触力增加，随后导致软骨修复部位的接触力增加，并可能导致更高的失败率。然而，冠状面错线对移植物存活率和临床结局的影响程度尚未得到很好的表征。目的： 评价内翻股骨髁 （MFC） 孤立 OCA 移植后内翻错位如何影响移植物存活和患者报告的结局。研究设计： 队列研究;证据水平， 3.方法： 从前瞻性收集的单外科医生软骨登记处确定了 2005 和 2019年间接受 MFC 初次 OCA 移植的 70 例患者 （74 例膝关节），随访至少 2 年。使用站立式髋关节到踝关节 X 光片评估冠状平面对齐。记录了 OCA 失败，定义为去除移植物或转换为关节置换术，以及再次手术。使用国际膝关节文献委员会评分、膝关节损伤和骨关节炎结果评分、改良的 Merle d'Aubigné-Postel 评分和患者总体满意度评分，在术前和术后获得患者报告的结局。结果： 内翻力线患者的平均胫股骨机械角为内翻 3.9° （范围，1.1° 至 8.9°），非内翻力线患者为外翻 0.02° （范围，内翻 3.6° 至 4.6° 外翻）。术后 5 年内翻组移植物存活率为 95.3%，非内翻组为 95.8% （P = .918）。OCA 移植后再次手术发生在 14.0% 的内翻组和 22 例。非内翻组的 6% （P = .336）。国际膝关节文献委员会平均总分从术前 45.2 分提高到内翻组最近一次随访时的 74.8 分，非内翻组从术前 40.5 分提高到最近一次随访时的 72.3 分。患者满意度为 >85%。结论： 接受 MFC 孤立 OCA 移植的患者移植物存活率高 （>90%），疼痛和功能有显著改善。与非内翻对线患者相比，先前存在的轻度内翻不线患者在失败率或临床结局方面没有差异。