首页> 外文期刊>Orthopaedic Journal of Sports Medicine >A Comparison of Functional and Radiographic Outcomes following Microfracture with Extracellular Matrix Augmentation versus Osteochondral Autograft Transplantation for the Treatment of Medium-Sized Osteochondral Lesions of the Talus
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A Comparison of Functional and Radiographic Outcomes following Microfracture with Extracellular Matrix Augmentation versus Osteochondral Autograft Transplantation for the Treatment of Medium-Sized Osteochondral Lesions of the Talus

机译:细胞外基质的微折叠函数和射线照相结果的比较与骨质色素自体移植治疗踝关节中的中型骨质色神经病变

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Objectives: The aim of this study is to directly compare clinical outcomes following the treatment of medium-sized osteochondral lesions of the talus (OLTs) using a microfracture technique augmented with Extracellular Matrix and Bone Marrow Aspirate Concentrate (MFX) versus OAT to determine which treatment is superior for medium-sized lesions. Methods: Patients treated for an OLT between 2015 and 2018 by a single surgeon, fellowship-trained in sports medicine and foot and ankle, were screened for this study. Retrospective chart review determined treatment, lesion size, lesion location, concurrent injuries, and demographic information. Patients at a minimum of 12 months follow-up, treated with MFX or OAT, and lesions sized 80-165mm2 were eligible for inclusion. All surgical repairs were augmented with an adjuvant mixture of micronized cartilage extracellular matrix and bone marrow aspirate concentrate (ECM-BMAC). Patient-reported functional outcomes were collected through our institution’s prospective Registry database. Patients treated prior to March 2016 were administered preoperative Foot and Ankle Outcome Score questionnaires. Those treated after this date were administered preoperative Physical Function, Pain Interference, Global Physical Health, Global Mental Health, Depression, and Pain Intensity Patient-Reported Outcome Information System (PROMIS) domains. Both FAOS and PROMIS were administered postoperatively. Postoperative MRIs were assessed using a modified magnetic resonance observation of cartilage repair tissue (MOCART) score. Student’s paired and two-group t-tests were used to evaluate for statistically significant pre-to-postoperative change and differences between procedure groups (p less than 0.05). Results: Twenty-seven patients treated with MFX (age range, 14-58) and twenty-three patients treated using OAT (age range, 22-64) were identified. All OAT patients received a single-plug transplantation. The final average lesion size ± standard deviation (SD) for patients treated with MFX was 115.44mm2± 22.51 (range, 156-80mm2) and 121.78mm2± 23.98 (range, 165-80mm2) for those treated using OAT (p=0.34). On average, functional outcome scores improved pre-to-postoperatively across all scales within both groups. Statistically significant improvements were detected in PROMIS Physical Function (Δ=8.32, p=0.01), Pain Interference (Δ=-7.15, p=0.02), Global Physical Health (Δ=5.87, p=0.03), and Pain Intensity (Δ=-7.06, p=0.05) domains for the MFX cohort. For the OAT patient group, significant pre-to-postoperative change was seen in the FAOS subcategories of Pain (Δ=28.70, p=0.03), Sports Activities (Δ=43.12, p&0.01), and Quality of Life (Δ=43.75, p=0.01); overall FAOS score (Δ=29.93, p=0.01); and PROMIS Physical Function (Δ=13.66, p=0.01), Pain Interference (Δ=-14.58, p&0.01), Global Physical Health (Δ=12.2, p=0.01), Depression (Δ=-4.13, p=0.02), and Pain Intensity (Δ=-16.56, p=0.02) domains. On average, with the exception of the postoperative Sports Activities subscale, postoperative FAOS and pre-to-postoperative change in FAOS were higher and greater in the OAT patient group. Similarly, on average, the OAT group had better PROMIS t-scores indicating higher function or less pain and greater pre-to-postoperative change in each PROMIS domain. The OAT cohort’s average postoperative Pain Interference t-score (± SD) of 43.09 (± 5.81) and Depression t-score of 40.06 (± 6.84) were significantly lower than their respective counterparts in the MFX cohort: 50.08 (± 9.47) for Pain Interference and 48.09 (± 7.86) in Depression. (Table 1) Finally, the mean overall MOCART score was 55.67 (± 24.11) within the MFX cohort, average follow-up 15.29 months, and 71 (± 15.60) within the OAT cohort average follow-up 15.8 months. This difference was also statistically significant (p=0.04). Conclusion: The OAT group had a higher MOCART score indicating the use of a single osteochondral autograft plug may result in better structural repair than microfracture abrasion chondroplasty augmented with a mixture of adjuvant ECM-BMAC. In addition, higher average FAOS scores, better average PROMIS t-scores, and greater pre-to-postoperative change in the OAT patient group indicate functional results may be better in this group as well. Specifically, significantly lower Pain Interference and Depression domains and significantly higher Global Mental Health scores indicate patients treated using OAT experience less pain and better psychological benefits postoperatively compared to patients treated using MFX. These results suggest filling the lesion with transplanted autograft bone and native, hyaline cartilage may perform better than and the biomechanically inferior fibrocartilage produced following microfracture even when augmented with adjuvant therapy. OAT may result in better overall clinical outcomes, specifically in a population of patients with medium sized lesions (range, 80 mm2 -165 mm2).
机译:目的:本研究的目的是使用微微裂缝技术使用细胞外基质和骨髓抽吸浓缩物(MFX)与燕麦来治疗踝(OLTS)的中尺寸骨细胞病变(OLTS)的中型骨质色神经病变进行比较临床结果,以确定哪种治疗方法中等大小的病变优于优越。方法:筛选于2015年至2018年间2015年至2018年间营养不良的患者,在体育医学和脚和脚踝中受过抚摸,对此研究进行了培训。回顾性图表审查确定的治疗,病变大小,病变位置,并发伤害和人口统计信息。患者至少12个月的随访,用MFX或OAT处理,病变大小为80-165mm2有资格包含。所有手术修理都会增加微粉化软骨细胞外基质和骨髓抽吸浓缩物(ECM-BMAC)的辅助混合物。患者报告的功能结果是通过我们机构的未来登记册数据库收集的。 2016年3月之前治疗的患者术前足部和踝关节结果评分问卷。在此日期治疗的那些治疗的术前物理功能,疼痛干扰,全球身体健康,全球心理健康,抑郁和疼痛强度患者报告的结果信息系统(PROMIS)域。派对和普罗斯队都被术后管理。使用软骨修复组织(MoCart)评分的改良磁共振观察评估术后MRI。学生配对和两组T检验用于评估统计学上显着的预期变化和程序组之间的差异(P小于0.05)。结果:二十七名患有MFX(年龄范围,14-58)和使用燕麦(年龄范围,22-64)治疗的二十三名患者治疗的患者。所有燕麦患者都接受了单塞移植。用MFX处理的患者的最终平均病变尺寸±标准偏差(SD)为115.44mm2±22.51(范围,156-80mm2)和121.78mm2±23.98(范围为165-80mm2),用于使用燕麦(P = 0.34) 。平均而言,功能结果分数在两组内的所有尺度上都会预先逐步改善。在PROMIS物理功能中检测到统计学显着的改进(Δ= 8.32,P = 0.01),疼痛干扰(Δ= -7.15,P = 0.02),全局物理健康(Δ= 5.87,P = 0.03)和疼痛强度(δ MFX Cohort = -7.06,p = 0.05)域。对于燕麦患者组,在粮食群体的疼痛子类别(δ= 28.70,p = 0.03),体育活动(δ= 43.12,P <0.01)和寿命质量(δ= 43.75,p = 0.01);总体粮农组织得分(δ= 29.93,P = 0.01);和促销物理功能(Δ= 13.66,p = 0.01),疼痛干扰(δ= -14.58,p <0.01),全局物理健康(δ= 12.2,p = 0.01),凹陷(δ= -4.13,p = 0.02 ),疼痛强度(δ= -16.56,p = 0.02)结构域。平均而言,除了术后体育活动的外卡,粮农组织博斯术后和粮农组织群体前的术后变化较高,燕麦患者群体更高。同样,平均而言,燕麦组具有更好的促销T形,表明每个PROMIS领域的疼痛更高或更少的疼痛和更高的术后变化。燕麦队队列的平均术后疼痛干扰T-得分(±5.81)和40.06(±6.84)的抑郁T-得分为40.06(±6.84)的疼痛:50.08(±9.47)的各自对应于疼痛显着低干扰和48.09(±7.86)抑郁症。 (表1)最后,MFX队列的平均整体MOCART得分为55.67(±24.11),平均随访15.29个月,71(±15.60),oat队列平均随访15.8个月。这种差异也存在统计学意义(p = 0.04)。结论:OAT组具有更高的MOCART评分,表明使用单个骨质色素自体移植塞可能会导致比微折衷磨损软骨成形术增加更好的结构修复,所述辅助ECM-BMAC的混合物增加。此外,粮农组织均额较高,平均平均促销T形象,燕麦患者组的更高术后变化表明该组也可能更好。具体而言,显着较低的疼痛干扰和抑郁症,并且显着更高的全球心理健康分数表明,与使用MFX治疗的患者相比,使用OAT经历较少疼痛和更好的心理效益。这些结果表明用移植的自体移植骨和天然的透明软骨填充病变可以表现优于微磨削后的生物力学劣质纤维纤维,即使在用佐剂治疗增加时也产生了微折磨。燕麦可能导致更好的整体临床结果,特别是在中等大小病变(范围,80mm2 -165mm2)的患者中。

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