Melissa L Carpenter, Eric J Cotter, Juan Bernardo Villarreal-Espinosa, Samuel Alfonsi, Fernando Gómez Verdejo, Cameron Gerhold, Udit Dave, Adam B Yanke, Brian J Cole, Jorge Chahla
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引用次数: 0
Abstract
Purpose: To conduct a systematic review evaluating subjective patient reported outcomes (PROs), reoperations, and graft failure after concomitant osteochondral allograft (OCA) transplantation and meniscal allograft transplantation (MAT).
Methods: A literature search was performed by querying MEDLINE, Embase, and PubMed according to the 2020 PRISMA statement. Inclusion criteria were limited to peer-reviewed English level I-IV studies with at least 10 patients reporting clinical outcomes and complications following OCA transplantation with concomitant MAT for osteochondral defects and meniscal deficiency with a minimum of 2-years follow up. For a majority of the included studies, failure was defined as conversion to arthroplasty, revision OCA, or graft failure on postoperative imaging.
Results: Six studies with a total of 188 patients met inclusion/exclusion criteria. The mean patient age was 32.4 years (Range 15 to 66 years). Improvement in the following outcome scores was observed across all included studies from pre- to postoperative status: Lysholm Knee Score (+21 to +26.69), International Knee Documentation Committee (IKDC) Subjective Knee Form (+19 to +26.55), Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain Score (+17.91 to +26), KOOS Symptom Score (+9 to +18.16), KOOS Activities of Daily Living (ADL) Score (+11.91 to +23.4), KOOS Sport Score (+19 to +26.04), KOOS Quality of Life Score (+22 to +35.01), 12-Item Short Form Survey (SF-12) Physical Score (+5 to +12.26), and SF-12 Mental Score (+1.8 to +4) (P < 0.05 for all). Reoperation rate was found to be between 6.7% and 54%. Failure rate was found to be between 13% and 22.9%. Although patient satisfaction data was only available in 2 studies, 82% - 90% of patients would choose to undergo OCA transplantation with MAT again.
Conclusion: OCA transplantation with concomitant MAT for the treatment of focal chondral defects in the presence of meniscus deficiency results in improved patient-reported outcome measures with high patient satisfaction rates. Reoperation rates and failure rates at a mean follow up time of 4.7 years (Range 1.7 to 17.1 years) are 37.3% and 17.1%, respectively, which are expected and consistent with the existing literature in isolated procedures.
Level of evidence: Level IV; Systematic Review of Level III-IV Studies.
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Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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