新鲜骨软骨移植膝关节的生物力学和功能效果：系统综述

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-03-22 DOI:10.1016/j.jcot.2025.102983

Stephanie Picioreanu , Leela Biant , Gwenllian Tawy

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引用次数: 0

摘要

新鲜骨软骨同种异体移植（FOCA）是治疗膝关节骨软骨病变的一种选择，这种病变会导致疼痛、锁定和关节不稳定。虽然FOCA旨在消除这些力学症状，但手术的生物力学结果仍然知之甚少。本系统综述旨在整理和解释有关FOCA生物力学结果的现有文献。方法以“膝关节”和“foa”或“新鲜骨软骨异体移植”或“新鲜OCA”为检索词，在3个数据库中进行系统检索。符合条件的研究包含客观的生物力学或功能结果，如膝关节活动范围、力量或步态参数。国家卫生质量评估工具研究所评估了研究质量。提取的数据在电子表格中合成，然后对可用的运动数据范围进行线性回归分析（p = 0.05）。为了便于对结果的解释，本分析中也包括了先前关于自体软骨细胞植入（ACI）的生物力学结果的系统综述数据。普洛斯彼罗id: crd42024531998。结果8项研究54名受试者符合纳入标准。每项研究平均包括10名参与者，随访时间为9-108个月。每项研究均报道术后膝关节活动度改善，一般报道术后活动度为>；120°。线性回归分析显示，最终活动范围与随访时间无相关性(p值- 0.860；R2 - 0.019)。这些结果与先前关于ACI结果的综述中报道的活动范围数据没有统计学差异(F = 0.003；p = 0.874)。一项研究也报告了在FOCA后膝关节力量的改善，而另外两项研究则评论了步态的改善，尽管没有提供多少数值数据。结论对膝关节活动范围改善的有限报道表明，FOCA有可能通过改善膝关节功能来改善患者的生活质量。本研究数据的线性回归分析和从ACI的生物力学结果的先前报告中获得的数据表明，两种手术后的膝关节活动范围是可比的。然而，进一步的研究需要更大的患者队列和一致的方法来证实现有的数据。这一知识对于通过循证康复规划优化结果非常重要。

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The biomechanical and functional outcomes of fresh osteochondral allograft for the knee: A systematic review

Background

Fresh osteochondral allograft (FOCA) is a treatment option for osteochondral lesions of the knee which cause pain, locking, and joint instability. While FOCA aims to eliminate these mechanical symptoms, the biomechanical outcomes of the procedure remain poorly understood. This systematic review aimed to collate and interpret the available literature on the biomechanical outcomes of FOCA.

Methods

Systematic searches were performed in three databases using the terms ‘(Knee OR knee joint) AND (FOCA OR fresh osteochondral allograft OR fresh OCA)’. Eligible studies contained objective biomechanical or functional outcomes, such as knee range of motion, strength, or parameters of gait. The National Institute of Health Quality Assessment Tool assessed study quality. Extracted data were synthesised in a spreadsheet and then a linear regression analysis was performed on the available range of motion data (p = 0.05). Data from a prior systematic review on the biomechanical outcomes of autologous chondrocyte implantation (ACI) were also included in this analysis to facilitate interpretation of the results. PROSPERO ID: CRD42024531998.

Results

Eight studies with 54 participants met the inclusion criteria. On average, studies included 10 participants with a follow up range of 9–108 months.

Knee range of motion was reported to improve post-operatively in each study, and the post-operative range of motion was generally reported to be > 120°. A linear regression analysis showed no correlation between final range of motion and follow-up time (p value – 0.860; R² - 0.019). These results did not differ statistically from the range of motion data reported in a prior review on ACI outcomes (F = 0.003; p = 0.874).

One study also reported an improvement in knee strength following FOCA, while two others commented on improvements to gait, although little numerical data was provided.

Conclusion

The limited reporting of improvements to knee range of motion suggest that FOCA has the potential to improve patient quality of life through improved knee function. Linear regression analyses of data presented in this study and obtained from a prior report on the biomechanical outcomes of ACI suggest that the knee ranges of motion following both procedures are comparable. However, further research with larger patient cohorts and consistent methodologies are required to corroborate existing data. This knowledge is important for optimising outcomes via evidence-based rehabilitation programmes.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.