Survival and Reoperation Rates After Meniscal Allograft Transplantation Analysis of Failures for 172 Consecutive Transplants at a Minimum 2-Year Follow-up
Survival and Reoperation Rates After Meniscal Allograft Transplantation Analysis of Failures for 172 Consecutive Transplants at a Minimum 2-Year Follow-up
复制标题
DOI：
10.1177/0363546513520115
复制
发表时间：
2014-04-01
影响因子：
4.8
通讯作者：
Cole, Brian J.
中科院分区：
文献类型：
--
作者：
McCormick, Frank;Harris, Joshua D.;Cole, Brian J.
背景：同种异体半月板移植(MAT)是治疗膝关节疼痛的一种选择，这些患者的半月板缺乏完整的关节表面、韧带的稳定性和正常的对齐。手术的频率越来越高，需要重新手术的情况并不少见。移植血管的平均存活率和再次手术的指征将是指导患者关于手术的有用信息。目的/假设：这项研究的目的是量化MAT的存活率，并报告再次手术的结果。研究设计：病例系列；证据水平，4。方法：对2003-2011年间接受MAT的前瞻性数据库进行回顾；所有手术均由一名外科医生进行。对再手术率、再次手术的时间、再次手术时的操作和手术结果，包括半月板和关节软骨的状况进行了回顾。生存被定义为缺乏翻修垫子或膝关节置换。结果：在200名接受MAT的患者中，172名患者(86%，平均年龄34.3+/-10.3岁)被评估，平均59个月(范围24-118个月)，至少2年的随访期。41%的垫片是隔离的，而60%的垫片是伴随程序进行的。64例患者(32%)在指引术后返回手术室。其中59%(38/)的患者接受了关节镜下清理术。再次手术的平均时间为21个月(2-107个月)，其中73%发生在2年内。172名患者中有8名(4.7%)需要翻修垫子或全膝关节置换术。在2年内需要二次手术的患者进行关节置换或翻修MAT的优势比为8.4(95%CI，1.6-43.4)(P=0.007)。结论：在本组患者中，MAT的再手术率为32%，其中简单的关节镜下清创是最常见的手术治疗(59%)，平均5年同种异体移植物存活率为95%。那些需要额外手术的人仍然受益，同种异体移植物存活率为88%，但失败的风险增加。在2年内需要二次手术的患者在未来的关节置换或垫子翻修术中的优势比为8.4。
Background:Meniscal allograft transplantation (MAT) is a treatment option for knee pain in young patients with meniscal deficiency in the setting of intact articular surfaces, ligamentous stability, and normal alignment. It is being performed with increasing frequency, and the need for reoperations is not uncommon. A mean survival rate of allografts and indications for reoperations would be helpful information when counseling patients regarding the procedure.Purpose/Hypothesis:The purpose of this study was to quantify survival for MAT and report findings at reoperation. The hypothesis was that the reoperation rate would be frequent and that the most common secondary surgery would be arthroscopic debridement.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review of a prospectively collected database of patients who underwent MAT from 2003 to 2011 was conducted; all surgeries were performed by a single surgeon. The reoperation rate, timing of reoperation, procedure performed at reoperation, and findings at surgery, including the status of the meniscal and articular cartilage, were reviewed. Survival was defined as a lack of revision MAT or knee arthroplasty. Descriptive statistics, log-rank testing, cross-tabulation, and chi(2) testing were analyzed, with an alpha value of .05 set as significant.Results:Of 200 patients who underwent MAT during the study period, 172 patients (86%; mean age, 34.3 +/- 10.3 years) were evaluated at a mean of 59 months (range, 24-118 months) with a minimum 2-year follow-up. Forty-one percent of MATs were isolated, while 60% were performed with concomitant procedures. Sixty-four patients (32%) returned to the operating room after their index procedure. Arthroscopic debridement was performed in 59% (38/64) of these patients. The mean time to subsequent surgery was 21 months (range, 2-107 months), with 73% occurring within 2 years. Eight of 172 patients (4.7%) went on to require revision MAT or total knee replacement. Patients requiring secondary surgery within 2 years had an odds ratio of 8.4 (95% CI, 1.6-43.4) for future arthroplasty or MAT revision (P = .007).Conclusion:In this series, there was a 32% reoperation rate for MAT, with simple arthroscopic debridement being the most common surgical treatment (59%), and a 95% allograft survival rate at a mean of 5 years. Those requiring additional surgery still benefited, having an 88% allograft survival rate, but were at an increased risk of failure. Patients requiring secondary surgery within 2 years had an odds ratio of 8.4 for future arthroplasty or MAT revision.