Comparison of Autologous Osteoperiosteal and Osteochondral Transplantation for the Treatment of Large, Medial Cystic Osteochondral Lesions of the Talus
Comparison of Autologous Osteoperiosteal and Osteochondral Transplantation for the Treatment of Large, Medial Cystic Osteochondral Lesions of the Talus
复制标题
自体骨骨膜和骨软骨移植治疗距骨内侧大囊性骨软骨病变的比较
DOI：
10.1177/03635465211068529
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发表时间：
2022-01-20
影响因子：
4.8
通讯作者：
Guo, Qinwei
中科院分区：
文献类型：
--
作者：
Shi, Weili;Yang, Shuai;Guo, Qinwei
背景：使用从髂嵴获取的移植物进行自体骨膜移植（AOPT）用于治疗距骨（OLT）的大囊性骨软骨病变。然而，尚无研究比较 AOPT 和自体骨软骨移植 (AOCT) 之间的临床和放射学结果，该移植使用从患有大囊性 OLT 的同侧膝关节股骨髁非承重区采集的移植物。目的：比较接受 AOPT 和接受 AOCT 治疗大型囊性 OLT 的患者的临床和放射学结果。研究设计：队列研究；证据水平，3。方法：对2015年3月至2018年3月期间接受AOCT和AOPT治疗内侧大囊性OLT（>10 mm）的患者进行回顾性评估。为了具有可比性，根据性别、年龄、体重指数、伤侧、随访时间、术前囊肿体积等特征，将两组患者进行1:1匹配。经过倾向评分匹配后，每组纳入 23 名患者进行分析。使用视觉模拟量表 (VAS)、美国骨科足踝协会 (AOFAS) 评分和 Tegner 评分来评估临床结果。根据症状记录供体部位发病率，包括疼痛、僵硬、肿胀和不适。此外，Lysholm 评分用于评估最常见的膝关节供体部位发病率。使用软骨修复组织磁共振观察（MOCART）评分评估放射学结果，并在复查手术期间获得国际软骨再生和关节保护协会（ICRS）评分。结果：平均随访期约为 48 个月。组间患者特征和病变体积没有显着差异。最终随访时，术后踝关节疼痛 VAS 评分、AOFAS 评分和 Tegner 评分在各组间无显着差异。 AOPT 组的供体部位总发病率 (P = .004) 和不适发病率 (P = .009) 显着低于 AOCT 组。然而，在 AOCT 组中，Lysholm 评分显示供体膝关节和对侧膝关节之间没有显着差异 (P = .503)。 MOCART 和 ICRS 评分在各组之间没有显着差异。结论：从髂嵴接受 AOPT 的患者的临床和影像学结果与从同侧膝关节接受 AOCT 治疗内侧大囊性 OLT 的患者相当。这些结果可能有助于骨科医生为患有大囊性 OLT 的患者决定适当的治疗方法。
Background: Autologous osteoperiosteal transplantation (AOPT) using graft harvested from the iliac crest is used to treat large cystic osteochondral lesions of the talus (OLTs). However, no studies have compared clinical and radiologic outcomes between AOPT and autologous osteochondral transplantation (AOCT) using graft harvested from the nonweightbearing zone of the femoral condyle of the ipsilateral knee in patients with large cystic OLTs. Purpose: To compare clinical and radiologic outcomes between patients undergoing AOPT and those undergoing AOCT for large cystic OLTs. Study Design: Cohort study; Level of evidence, 3. Methods: Between March 2015 and March 2018, patients who underwent AOCT and AOPT to treat medial large cystic OLTs (>10 mm) were retrospectively evaluated. For comparability, the 2 groups were matched 1:1 based on their characteristics, including sex, age, body mass index, side of injury, follow-up period, and the preoperative cyst volume. After propensity score matching, 23 patients were enrolled in each group for the analysis. Clinical outcomes were assessed using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the Tegner score. Donor-site morbidity was recorded according to the symptoms, including pain, stiffness, swelling, and discomfort. In addition, the Lysholm score was used to assess the most common knee donor-site morbidity. Radiologic outcomes were evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) score, and the International Cartilage Regeneration & Joint Preservation Society (ICRS) score was obtained during second-look surgery. Results: The mean follow-up period was about 48 months. There were no significant differences in patient characteristics and lesion volumes between groups. Postoperative ankle pain VAS score, AOFAS score, and Tegner score were not significantly different between groups at final follow-up. Total donor-site morbidity (P = .004) and discomfort morbidity (P = .009) were significantly lower in the AOPT group than in the AOCT group. However, the Lysholm score showed no significant difference between the donor knee and the opposite knee (P = .503) in the AOCT group. The MOCART and ICRS scores were not significantly different between groups. Conclusion: Clinical and radiologic outcomes of patients who underwent AOPT from the iliac crest were found to be comparable with those of patients who underwent AOCT from the ipsilateral knee for the treatment of medial large cystic OLTs. These results may be helpful for orthopaedic surgeons to decide appropriate treatments for patients with large cystic OLTs.