免疫超敏与膝关节骨软骨异体移植物移植后较高的移植物失败率有关

Q3 Medicine Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-06-01 DOI:10.1016/j.asmr.2024.100933

Michael Moore B.A., Luilly Vargas M.D., Idris Hanidu B.S., Samuel Zverev B.S., Andrew Bi M.D., Jairo Triana B.S., Guillem Gonzalez Lomas M.D., Laith Jazrawi M.D., Eric Strauss M.D., Kirk A. Campbell M.D.

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引用次数: 0

摘要

目的分析膝关节骨软骨异体移植物移植（OCA）后患者报告的一种或多种过敏症对临床结果（尤其是移植物失败率）和患者报告结果（PROs）的影响。方法回顾性研究 2010 年 8 月至 2021 年 5 月期间接受膝关节 OCA 的患者，至少随访 2 年。最初将患者分为两组：至少有一种过敏症的患者和没有任何过敏症的患者。评估的临床结果包括移植物失败、再次手术率、深静脉血栓/肺栓塞、麻醉下操作/粘连溶解（MUA/LOA）。结果共纳入285名患者，平均临床随访时间为（4.8 ± 2.0）年。过敏人群的移植物失败率明显更高（P = .008）。在控制混杂变量的回归分析中，移植物失败仍与药物过敏显著相关（几率比 [OR]，3.631；95% CI，1.139-11.577；P = .029）。此外，过敏次数的增加与移植物失败率的增加有关（OR，1.644；95% CI，1.074-2.515；P = .022）。再次手术率、并发症、感染和 MUA/LOA 没有差异。在 100 名填写了 PROs 的患者中，VAS 满意度、疼痛、任何 KOOS 结果评分或恢复运动能力均无差异。此外，患者报告的过敏次数越多，移植失败率越高。然而，在 VAS 满意度或疼痛、KOOS 症状、生活质量、疼痛或恢复运动方面，至少有 1 例患者报告过敏的患者与没有过敏的患者没有明显差异。

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Immune Hypersensitivity Is Associated With Higher Graft Failure Rate After Osteochondral Allograft Transplantation of the Knee

Purpose

To analyze the effects of 1 or more patient-reported allergies on clinical outcomes, in particular graft failure rate, and patient-reported outcomes (PROs) following osteochondral allograft transplantation (OCA) of the knee.

Methods

Retrospective review of patients who underwent knee OCA from August 2010 to May 2021 with a minimum of 2-year follow-up. Patients were initially divided into 2 cohorts: those with at least 1 allergy and those without any allergies. Clinical outcomes assessed included graft failure, reoperation rates, deep vein thrombosis/pulmonary embolism, and manipulation under anesthesia/lysis of adhesions (MUA/LOA). PROs assessed, including the visual analog scale (VAS) for pain and satisfaction, the Knee injury and Osteoarthritis Outcome Score (KOOS), and return to sport rates, were compared.

Results

In total, 285 patients were included with a mean clinical follow-up of 4.8 ± 2.0 years. The allergy cohort had a significantly higher rate of graft failure (P = .008). In a regression analysis controlling for confounding variables, graft failure remained significantly associated with the presence of medication allergies (odds ratio [OR], 3.631; 95% CI, 1.139-11.577; P = .029). Furthermore, an increasing number of allergies were associated with an increased rate of graft failure (OR, 1.644; 95% CI, 1.074-2.515; P = .022). There was no difference in rate of reoperation, complications, infection, and MUA/LOA. Of the 100 patients who completed PROs, there was no difference in VAS satisfaction, pain, and any of the KOOS outcome scores or return to sport.

Conclusions

The presence of 1 or more patient-reported allergies was shown to be significantly associated with OCA graft failure. Furthermore, an increasing number of patient-reported allergies were associated with a higher rate of graft failure. However, there were no significant differences in VAS satisfaction or pain, KOOS symptom, quality of life, pain, or return to sport in patients with at least 1 patient-reported allergy and those without allergies.