Favorable 10-year outcomes of osteochondral autologous transplantation for spontaneous osteonecrosis of the knee following subchondral insufficiency fracture with optimal alignment correction.

IF 4.4 Q2 Medicine
Kohei Nishitani, Yasuaki Nakagawa, Masahiko Kobayashi, Shinichiro Nakamura, Shogo Mukai, Shinichi Kuriyama, Shuichi Matsuda
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引用次数: 0

Abstract

Purpose: The long-term effect of osteochondral autologous transplantation (OAT) on spontaneous osteonecrosis of the knee (SONK) following subchondral insufficiency fracture remains unclear. This study aimed to evaluate the long-term survivorship and clinical outcomes of OAT for SONK, with a focus on factors associated with clinical success.

Methods: Patients who underwent OAT for SONK between 1998 and 2009 were retrospectively reviewed. Survivorship was assessed using Kaplan-Meier analysis, with revision surgery as the endpoint. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) subjective score obtained preoperatively and at final follow-up. Clinical failure was defined as an IKDC score below the patient acceptable symptom state (PASS; 62.1 points). The association between final IKDC score and postoperative femorotibial angle (FTA) was analyzed using linear and quadratic regression.

Results: A total of 33 OATs were included (mean age: 64.6 ± 8.0 years; mean lesion size: 3.9 ± 1.7 cm2). High tibial osteotomy was performed in 15 patients with FTA > 180°, and 24 patients were followed for ≥ 10 years (mean: 13.7 ± 3.4 years). One arthroplasty was performed at 14.2 years, yielding a 15-year survival rate of 88%. The IKDC score improved significantly (35.0 ± 12.6 to 70.6 ± 14.1, p < 0.001), with a clinical success rate of 79.2%. Quadratic regression showed optimal postoperative FTA between 163.1° and 178.3° for achieving PASS.

Conclusions: OAT may provide favorable long-term survivorship and clinical outcomes in SONK, particularly when postoperative alignment is appropriately corrected.

自体骨软骨移植治疗膝关节软骨下不全骨折后自发性骨坏死的10年预后良好。
目的:骨软骨自体移植(OAT)对软骨下不全骨折后自发性膝骨坏死(SONK)的长期影响尚不清楚。本研究旨在评估OAT治疗SONK的长期生存期和临床结果,重点关注与临床成功相关的因素。方法:回顾性分析1998 ~ 2009年间因SONK接受OAT治疗的患者。生存率采用Kaplan-Meier分析,以翻修手术为终点。临床结果采用国际膝关节文献委员会(IKDC)术前和最终随访时的主观评分进行评估。临床失败定义为IKDC评分低于患者可接受症状状态(PASS;62.1分)。采用线性和二次回归分析最终IKDC评分与术后股胫角(FTA)的关系。结果:共纳入33例oat患者(平均年龄64.6±8.0岁;平均病灶大小:3.9±1.7 cm2)。15例ftb0 180°患者行胫骨高位截骨术,24例随访≥10年(平均:13.7±3.4年)。14.2年时进行了一次关节置换术,15年生存率为88%。IKDC评分显著提高(35.0±12.6至70.6±14.1,p)。结论:OAT可能提供良好的SONK长期生存期和临床结果,特别是在术后对齐得到适当纠正时。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.50
自引率
0.00%
发文量
42
审稿时长
19 weeks
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