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Wang X, Ren Z, Liu Y, Ma Y, Huang L, Song W, Lin Q, Zhang Z, Li P, Wei X, Duan W. Characteristics and Clinical Outcomes After Osteochondral Allograft Transplantation for Treating Articular Cartilage Defects: Systematic Review and Single-Arm Meta-analysis of Studies From 2001 to 2020. Orthop J Sports Med 2023; 11:23259671231199418. [PMID: 37745815 PMCID: PMC10515554 DOI: 10.1177/23259671231199418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/03/2023] [Indexed: 09/26/2023] Open
Abstract
Background Osteochondral allograft transplantation (OCA) treats symptomatic focal cartilage defects with satisfactory clinical results. Purpose To comprehensively analyze the characteristics and clinical outcomes of OCA for treating articular cartilage defects. Study Design Systematic review; Level of evidence, 4. Methods We searched Embase, PubMed, Cochrane Database, and Web of Science for studies published between January 1, 2001, and December 31, 2020, on OCA for treating articular cartilage defects. Publication information, patient data, osteochondral allograft storage details, and clinical outcomes were extracted to conduct a comprehensive summative analysis. Results In total, 105 studies involving 5952 patients were included. The annual reported number of patients treated with OCA increased from 69 in 2001 to 1065 in 2020, peaking at 1504 cases in 2018. Most studies (90.1%) were performed in the United States. The mean age at surgery was 34.2 years, and 60.8% of patients were male and had a mean body mass index of 26.7 kg/m2. The mean lesion area was 5.05 cm2, the mean follow-up duration was 54.39 months, the mean graft size was 6.85 cm2, and the number of grafts per patient was 54.7. The failure rate after OCA was 18.8%, and 83.1% of patients reported satisfactory results. Allograft survival rates at 2, 5, 10, 15, 20, and 25 years were 94%, 87.9%, 80%, 73%, 55%, and 59.4%, respectively. OCA was mainly performed on the knee (88.9%). The most common diagnosis in the knee was osteochondritis dissecans (37.9%), and the most common defect location was the medial femoral condyle (52%). The most common concomitant procedures were high tibial osteotomy (28.4%) and meniscal allograft transplantation (24.7%). After OCA failure, 54.7% of patients underwent revision with primary total knee arthroplasty. Conclusion The annual reported number of patients who underwent OCA showed a significant upward trend, especially from 2016 to 2020. Patients receiving OCA were predominantly young male adults with a high body mass index. OCA was more established for knee cartilage than an injury at other sites, and its best indication was osteochondritis dissecans. This analysis demonstrated satisfactory long-term postoperative outcomes.
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Affiliation(s)
- Xueding Wang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Zhiyuan Ren
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Yang Liu
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Yongsheng Ma
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Lingan Huang
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Wenjie Song
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Qitai Lin
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Zhipeng Zhang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Pengcui Li
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Xiaochun Wei
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Wangping Duan
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
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Zhou Y, Li H, Cao S, Han Y, Shao J, Fu Q, Wang B, Wu J, Xiang D, Liu Z, Wang H, Zhu J, Qian Q, Yang X, Wang S. Clinical Efficacy of Intra-Articular Injection with P-PRP Versus that of L-PRP in Treating Knee Cartilage Lesion: A Randomized Controlled Trial. Orthop Surg 2023; 15:740-749. [PMID: 36647244 PMCID: PMC9977604 DOI: 10.1111/os.13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Platelet-rich plasma(PRP), with different concentration of leukocytes, may lead to varying effects in the treatment of cartilage lesions. So far, current research has not shown enough evidence on this. To evaluate the clinical efficacy and safety of intra-articular injection with pure platelet-rich plasma (P-PRP) versus those of leukocyte platelet-rich plasma (L-PRP) in treating knee cartilage lesions, we conducted a double-blind, randomized controlled clinical trial with a larger sample and longer follow-up period. METHODS From October 2019 to October 2020, 95 patients were invited to participate in our study, and 60 (63.2%) were randomized to P-PRP (n = 30) or L-PRP (n = 30) groups. Patients from the two groups were treated with knee intra-articular injections of P-PRP or L-PRP. Visual analog scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were assessed using an unpaired t-test for independent samples preoperatively and at 6 weeks, 12 weeks, 6 months, and 12 months after intervention. RESULTS We followed up 27 cases in the P-PRP group and 26 cases in the L-PRP group. No significant differences in VAS and WOMAC scores were found between the two groups before the intervention (p > 0.05). The WOMAC Pain and VAS-Motions scores of the P-PRP group were significantly lower than those of the L-PRP group at 6 weeks after the intervention (p < 0.05). While the long-term clinical efficacy of both injections was similar and weakened after 12 months, more adverse events were found in the L-PRP group. CONCLUSIONS The short-term results demonstrate a positive effect in reducing pain and improving function in patients with knee cartilage lesions in the two groups. While the P-PRP injection showed better clinical efficacy in the early phase of postoperative rehabilitation and resulted in fewer adverse events, long-term follow-up showed similar and weakened efficacy after 12 months. TRIAL REGISTRATION ChiCTR1900026365. Registered on October 3, 2019, http://www.chictr.org.cn/showproj.aspx?proj=43911.
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Affiliation(s)
- Yiqin Zhou
- Department of Radiology, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina,Department of Orthopedics, Shanghai Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Haobo Li
- Department of Orthopedics, Shanghai Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Shiqi Cao
- Department of OrthopaedicsChinese PLA General HospitalBeijingChina,Department of Orthopaedics of TCM Clinical Unit, 6th Medical CenterChinese PLA General HospitalBeijingChina
| | - Yaguang Han
- Department of Orthopedics, Shanghai Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Jiahua Shao
- Department of Orthopedics, Shanghai Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Qiwei Fu
- Department of Orthopedics, Shanghai Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Bo Wang
- Department of Orthopedics, Shanghai Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Jun Wu
- Department of Orthopedics, Shanghai Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Dong Xiang
- Department of Orthopedics, Shanghai Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Ziye Liu
- Department of Orthopedics, Shanghai Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Huang Wang
- Department of Orthopedics, Shanghai Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Jun Zhu
- Department of Orthopedics, Shanghai Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Qirong Qian
- Department of Orthopedics, Shanghai Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Xiaolei Yang
- Department of Anesthesiology, Shanghai Changzheng HospitalNaval Medical UniversityShanghaiChina
| | - Song Wang
- Department of Radiology, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
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Guo H, Chen Z, Wei Y, Chen B, Sun N, Liu Y, Zeng C. Autologous Osteoperiosteal Transplantation for the Treatment of Large Cystic Talar Osteochondral Lesions. Orthop Surg 2022; 15:103-110. [PMID: 36380533 PMCID: PMC9837294 DOI: 10.1111/os.13586] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/21/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The effectiveness of autologous osteoperiosteal transplantation (AOPT) for the treatment of large cystic talar osteochondral lesions (OCLs) should be further evaluated, and the postoperative cartilage coverage is questionable. The purpose of this retrospective observational study was to investigate the clinical outcomes of AOPT for the treatment of large cystic talar OCLs and to report second-look arthroscopic results. METHODS From June 1, 2017, to June 1, 2021, all talar OCLs at our center were reviewed. Painful cystic lesions treated with AOPT were included in the study. The American Orthopaedic Foot and Ankle Society (AOFAS; 0-100 points) ankle-hindfoot score, Foot Function Index (FFI; 0-100 points), visual analog scale (VAS; 0-10 points) score, and Tegner score (0-10 points) were used to describe pain and functional outcomes. Furthermore, complications, patient-reported satisfaction degrees, imaging results (including computed tomography and magnetic resonance), and second-look arthroscopic evaluation data were also collected for analysis. RESULTS A total of 29 cases were eligible for the study, and 26 responded to the latest follow-up request, with a mean follow-up duration of 30.2 (range, 12-57) months. The AOFAS score improved from 69.2 ± 10.9 preoperatively to 80.9 ± 10.0 at the latest follow-up (p = 0.000). The FFI score improved from 30.4 ± 18.4 preoperatively to 16.3 ± 14.0 at the latest follow-up (p = 0.000). The VAS pain score improved from 4.0 ± 2.1 preoperatively to 2.5 ± 2.0 at the latest follow-up (p = 0.001). No donor site morbidity was found. The mean postoperative MOCART score was 57.7 ± 9.5. Second-look arthroscopy showed a fibrillated cartilage-like surface at the lesion site in most cases, while two cases exhibited a nearly normal surface. CONCLUSION The transplantation of osteoperiosteal cylinder autografts taken from the iliac crest for the treatment of large cystic talar OCLs yielded acceptable clinical results. Good integration of the bony part was observed, but cartilage regeneration remained uncertain.
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Affiliation(s)
- Hao Guo
- Department of Foot and Ankle Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Zhuhong Chen
- Department of Foot and Ankle Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Yuxuan Wei
- Department of Foot and Ankle Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Botao Chen
- Department of Foot and Ankle Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Nian Sun
- Department of Foot and Ankle Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Yijun Liu
- Department of Foot and Ankle Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Canjun Zeng
- Department of Foot and Ankle Surgery, Center for Orthopaedic SurgeryThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
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Zhao Z, Li J, Bai X, Wang Y, Wang Q, Lv N, Gao H, Guo Z, Zhu H, Guo Q, Li Z. Microfracture Augmentation With Direct In Situ Radial Shockwave Stimulation With Appropriate Energy Has Comparable Repair Performance With Tissue Engineering in the Porcine Osteochondral Defect Model. Am J Sports Med 2022; 50:3660-3670. [PMID: 36190157 DOI: 10.1177/03635465221125936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The first-line clinical strategy for small cartilage/osteochondral defects is microfracture (MF). However, its repair efficacy needs improvement. HYPOTHESIS Appropriate energy radial shockwave stimulation in MF holes would greatly improve repair efficacy in the porcine osteochondral defect model, and it may obtain comparable performance with common tissue engineering techniques. STUDY DESIGN Controlled laboratory study. METHODS Osteochondral defect models (8-mm diameter, 3-mm depth) were established in the weightbearing area of Bama pigs' medial femoral condyles. In total, 25 minipigs were randomly divided into 5 groups: control (Con; without treatment), MF, MF augmentation (MF+; treated with appropriate energy radial shockwave stimulation in MF holes after MF), tissue engineering (TE; treated with compounds of microcarrier and bone marrow mesenchymal stem cells), and sham (as the positive control). After 3 months of intervention, osteochondral specimens were harvested for macroscopic, radiological, biomechanical, and histological evaluations. The statistical data were analyzed using 1-way analysis of variance. RESULTS Based on the macroscopic appearance, the smoothness and integration of the repaired tissue in the MF+ group were improved when compared with the Con and MF groups. The histological staining suggested more abundant cartilaginous matrix deposition in the MF+ group versus the Con and MF groups. The general scores of the macroscopic and histological appearances were comparable in the MF+ and the TE groups. The high signal areas of the osteochondral unit in the magnetic resonance images were significantly decreased in the MF+ group, with no difference with the TE group. The micro-computed tomography data demonstrated the safety of direct in situ radial shockwave performance. Biomechanical tests revealed that the repaired tissue's Young modulus was highest in the MF+ group and not statistically different from that in the TE group. CONCLUSION Direct in situ radial shockwave stimulation with appropriate energy significantly improves the short-term repair efficacy of MF. More encouragingly, the MF+ group in our study obtained repair performance comparable with the TE therapy. CLINICAL RELEVANCE This strategy is easy to perform and can readily be generalized with safety and higher cartilage repair efficacy. Moreover, it is expected to be accomplished under arthroscopy, indicating tremendous clinical transformative value.
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Affiliation(s)
- Zhidong Zhao
- Department of Orthopedics, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ji Li
- Department of Orthopedics, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaowei Bai
- Department of Orthopedics, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yuxing Wang
- Department of Orthopedics, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qi Wang
- Department of Orthopedics, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ningyu Lv
- Department of Orthopedics, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Huayi Gao
- Department of Orthopedics, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zheng Guo
- Department of Orthopedics, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Heng Zhu
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Quanyi Guo
- Department of Orthopedics, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhongli Li
- Department of Orthopedics, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
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