Background:Osteochondral allograft transplantation (OCAT) has become a standard-of-care treatment option for patients with large symptomatic articular defects. Recent advances in allograft science and OCAT protocols have been reported to result in consistently robust outcomes after OCAT in the knee. However, only short-term comparisons have been reported, and analyses are lacking for treatment failure risk factors that account for confounding variables.Hypothesis:Midterm functional graft survival rate would exceed 80% for all OCATs combined, with consideration of risk factors for lower survivorship including older patient age, higher body mass index (BMI), tibiofemoral bipolar OCAT, and nonadherence to prescribed postoperative rehabilitation protocols.Study Design:Case series; Level of evidence, 4.Methods:Patients with outcome data available at ≥5 years after primary OCAT using high chondrocyte–viability (HCV) osteochondral allografts were analyzed according to 2 clinically relevant definitions: (1) initial treatment failure, defined by revision or arthroplasty surgery performed for the primary OCAT at any time point during the study period; and (2) functional graft failure, defined by documented conversion to arthroplasty after primary or revision OCAT at any time point during the study period. Analyses were used to assess outcomes for each definition, separately for age group, sex, obesity status, tobacco use, type of OCAT surgery, osteotomy status, concurrent ligament surgery status, and adherence to postoperative protocols. Kaplan-Meier analyses were used to assess differences in survival rates, and Cox proportional hazards models were used to assess risk factors and multivariable relationships with survival. Patient-reported outcome measures for pain, function, mobility, and satisfaction were also analyzed.Results:Analysis included 137 primary knee OCATs performed in 134 patients with a mean follow-up of 66 months (59 female, 75 male; mean age, 37.8 years; mean BMI, 28.5). The midterm (5- to 8-year) functional graft survival rate for patients undergoing primary OCAT in the knee using HCV grafts was 82% for all cases combined, ranging from 69% for tibiofemoral bipolar HCV OCATs to 89% for patellofemoral bipolar, 94% for multisurface unipolar, and 97% for single-surface unipolar. Initial treatment failure rates (revision or arthroplasty after primary OCAT) and OCAT nonsurvival rates (arthroplasty after primary or revision OCAT) were greater for older patient age, concurrent ligament reconstruction, tibiofemoral bipolar OCAT, and nonadherence to the prescribed postoperative rehabilitation protocols. When adjusted for patients’ age, BMI, and tobacco use status, different surgery types did not demonstrate an increased risk for failure, while concurrent ligament reconstruction and nonadherence did. Patients who experienced functional graft survival after primary OCAT reported significantly greater improvements in PROMIS Physical Function and Mobility (Patient-Reported Outcomes Measurement Information System), International Knee Documentation Committee questionnaire, and Single Assessment Numeric Evaluation scores such that they were significantly higher at final follow-up as compared with patients who required arthroplasty. Patient-reported improvements in pain, function, and mobility exceeded minimal clinically important differences for ≥5 years after primary OCAT. When asked if they were satisfied with primary OCAT surgery, 76.2% of patients were very satisfied or satisfied with their results, while 8.5% were neutral and 15.4% were unsatisfied or very unsatisfied.Conclusion:With use of HCV osteochondral allografts, midterm (5- to 8-year) functional graft survival rates for patients undergoing primary OCAT in the knee were notably higher than previously reported midterm rates for traditional OCATs. When adjusted for patient characteristics, risk factors for nonsurvival included concurrent ligament reconstruction for knee instability and nonadherence to the prescribed postoperative rehabilitation protocols. Patients who experienced functional graft survival for ≥5 years after primary OCAT reported statistically significant and clinically meaningful improvements in pain, function, and mobility.

中文翻译：

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使用高软骨细胞活力移植物进行膝关节同种异体骨质移植后的中期结果


背景： 同种异体骨软骨移植术 （OCAT） 已成为大症状性关节缺损患者的标准治疗选择。据报道，同种异体移植科学和 OCAT 方案的最新进展导致膝关节 OCAT 后始终如一的稳健结果。然而，仅报道了短期比较，并且缺乏对解释混杂变量的治疗失败风险因素的分析。假设： 考虑到生存率较低的危险因素，包括患者年龄较大、体重指数 （BMI） 较高、胫股骨双极 OCAT 和不遵守规定的术后康复方案，所有 OCAT 的中期功能移植物存活率将超过 80%。研究设计： 病例系列;证据水平， 4.方法： 根据 2 个临床相关定义分析初次 OCAT 后 ≥5 年使用高软骨细胞同种异体骨移植物获得结果数据的患者： （1） 初始治疗失败，定义为在研究期间的任何时间点对原发性 OCAT 进行翻修或关节置换手术;（2） 功能性移植失败，定义为在研究期间的任何时间点初次或翻修 OCAT 后记录的转换为关节成形术。分析用于评估每个定义的结局，分别针对年龄组、性别、肥胖状况、烟草使用、OCAT 手术类型、截骨状态、并发韧带手术状态和对术后方案的依从性。采用 Kaplan-Meier 分析评估生存率的差异，采用 Cox 比例风险模型评估危险因素和与生存率的多变量关系。 还分析了患者报告的疼痛、功能、活动能力和满意度的结局指标。结果： 分析包括在 134 例患者中进行的 137 例初次膝关节 OCATs，平均随访 66 个月 （59 例女性，75 例男性;平均年龄 37.8 岁;平均 BMI，28.5）。使用 HCV 移植物在膝关节接受原发性 OCAT 的患者的中期（5 至 8 年）功能性移植物存活率在所有病例中为 82%，范围从胫股双极 HCV OCAT 的 69% 到髌股双极的 89%、多表面单极的 94% 和单表面单极的 97%。对于年龄较大的患者、并发韧带重建、胫股双极 OCAT 和不遵守规定的术后康复方案，初始治疗失败率 （初次或翻修 OCAT 后的翻修或关节成形术） 和 OCAT 非存活率 （初次或翻修 OCAT 后的关节成形术） 更高。当根据患者的年龄、 BMI 和烟草使用状况进行调整时，不同的手术类型并未显示失败风险增加，而同时进行韧带重建和不依从性则显示失败风险增加。原发性 OCAT 后经历功能性移植物存活的患者报告称，PROMIS 身体功能和活动度 （患者报告结果测量信息系统） 、国际膝关节文献委员会问卷和单一评估数字评估评分的改善显著更大，因此在最终随访时与需要关节置换术的患者相比，它们显着更高。在初次 OCAT 后 ≥5 年，患者报告的疼痛、功能和活动能力的改善超过了最小的临床重要差异。当被问及他们对初次 OCAT 手术是否满意时，76.2% 的患者对他们的结果非常满意或满意，而 8.5% 的患者是中性的，15.4% 的患者不满意或非常不满意。结论： 使用 HCV 同种异体骨软骨移植物，膝关节初次 OCAT 患者的中期 （5 至 8 年） 功能性移植物生存率显著高于既往报道的传统 OCATs 中期生存率。当根据患者特征进行调整时，非生存的危险因素包括膝关节不稳定的同步韧带重建和不遵守规定的术后康复方案。初次 OCAT 后功能性移植物存活 ≥5 年的患者报告了疼痛、功能和活动度的统计学意义和临床意义的改善。