骨髓抽吸物增强降低膝关节骨软骨同种异体移植术后再手术率：一项系统综述
简介
一项系统综述纳入4项研究（165膝，随访5.5–18个月），比较膝关节骨软骨同种异体移植联合或不联合骨髓抽吸物（BMA）增强的疗效。BMA增强组再手术率显著更低（2.4% vs 21.9%），但影像学结果异质，MRI评分及患者报告结局多无差异。临床提示BMA增强或可减少短期再手术，但样本小、随访短，证据等级有限。
英文摘要
PURPOSE: To systematically review the clinical, radiographic, and patient-reported outcomes of osteochondral allograft (OCA) transplantation with versus without bone marrow aspirate (BMA) augmentation for the treatment of knee cartilage defects. METHODS: A comprehensive search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparative clinical studies assessing OCA with and without BMA were included. Two reviewers independently performed screening, data extraction, and methodological quality assessment using the Cochrane Risk of Bias Tool 2.0 for randomized trials and the Methodological Index for Non-Randomized Studies for nonrandomized studies. RESULTS: Four studies (3 Level III, 1 Level I) involving 165 knees met the inclusion criteria. The mean follow-up duration across studies ranged from 5.5 to 18.0 months. Across 2 comparative studies, BMA augmentation was associated with fewer reoperations (2.4% vs 21.9%) compared with non-BMA augmentation. Radiographic findings were heterogeneous: 1 study showed earlier integration and reduced sclerosis with BMA at 6 months, whereas 2 magnetic resonance imaging-based studies showed no differences in OCA Magnetic Resonance Imaging Scoring System scores. Computed tomography assessment in 1 trial found increased small cysts but a trend toward fewer large cysts in BMA-treated grafts. Patient-reported outcomes from 1 study showed no significant differences in International Knee Documentation Committee or Knee injury and Osteoarthritis Outcome Score for Joint Replacement scores between groups, although achievement of the Knee injury and Osteoarthritis Outcome Score for Joint Replacement minimal clinically important difference favored the BMA cohort (88% vs 55%; P = .076). CONCLUSIONS: OCA transplantation augmented with BMA is associated with significantly lower reoperation rates compared with nonaugmented transplantation. Although short-term radiographic data show improved early subchondral remodeling, these findings are not consistently corroborated by magnetic resonance imaging-based scores. LEVEL OF EVIDENCE: Level III, systematic review of Level I and III studies.