Background: Primary osteochondral allograft transplantation (OCA) of the knee has been shown to improve patient-reported outcome measure (PROM) scores at various follow-up time points. However, studies analyzing the effects of patient sex on primary OCA outcomes remain limited and show conflicting results. Purpose: To compare PROM scores and clinically significant outcome (CSO) achievement rates at a minimum 5-year follow-up between male and female patients who underwent primary OCA of the knee. Study Design: Cohort study; Level of evidence, 3. Methods: A prospectively collected database was queried for patients who underwent primary OCA, regardless of the presence of concomitant procedures, between January 2003 and January 2018. Inclusion criteria consisted of (1) primary OCA, (2) a minimum 5-year follow-up, and (3) age >18 years at the time of OCA. Patient characteristics, intraoperative variables, PROM scores, reoperations, and failures were compared. Rates of achieving the CSOs of the minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) were compared at 5-year follow-up for the International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Regression analyses were performed to determine the factors associated with achieving the MCID, PASS, or SCB. Results: A total of 235 patients (119 female, 116 male) with a mean age of 31.0 ± 9.5 years, a mean follow-up of 6.5 years, and a mean body mass index of 26.7 ± 4.2 kg/m 2 were included in this study. Male patients had a higher body mass index (28.0 ± 4.3 vs 25.5 ± 3.8 kg/m 2 , respectively; P < .001), larger medial femoral condyle defects (20.2 ± 4.5 vs 17.7 ± 3.5 mm, respectively; P < .001), and larger lateral femoral condyle defects (20.3 ± 4.0 vs 18.1 ± 3.1 mm, respectively; P = .002) and were more likely to undergo concomitant osteotomy (24.1% vs 13.4%, respectively; P = .036), particularly concomitant high tibial osteotomy (14.7% vs 3.4%, respectively; P = .002), compared with female patients. At baseline, male patients had higher IKDC (41.8 ± 15.1 vs 33.3 ± 15.2, respectively; P = .003) and KOOS Sport (35.2 ± 24.1 vs 25.1 ± 22.0, respectively; P = .032) scores compared with female patients. At a minimum 5-year follow-up, female patients demonstrated higher Lysholm (79.6 ± 15.9 vs 73.8 ± 15.6, respectively; P = .026) and KOOS Pain (82.6 ± 16.9 vs 79.1 ± 13.7, respectively; P = .049) scores and achieved the MCID for the KOOS Sport (75.7% vs 46.7%, respectively; P = .015), the PASS for the KOOS Quality of Life (89.6% vs 67.3%, respectively; P = .003), and the SCB for the KOOS Sport (64.9% vs 23.3%, respectively; P < .001) at higher proportions than male patients. On multivariate regression analysis, male sex was associated with decreased odds of achieving the MCID (odds ratio, 0.234 [95% CI, 0.086-0.636]; P = .004) and SCB (odds ratio, 0.433 [95% CI, 0.205-0.917]; P = .028) for the IKDC score. Reoperations occurred in 37.9% of patients, and failure occurred in 26.8% of patients, with male and female patients demonstrating comparable rates for both. Conclusion: Despite male patients exhibiting higher preoperative scores for certain PROMs, female patients demonstrated higher or comparable postoperative PROM scores and CSO achievement rates after primary OCA of the knee at a minimum 5-year follow-up. Male sex was significantly associated with decreased odds of achieving the MCID and SCB for the IKDC score.

中文翻译：

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至少 5 年随访中膝关节初次同种异体骨质移植术后临床显着结果实现的基于性别的差异


背景： 膝关节原发性同种异体骨移植物移植 （OCA） 已被证明可以提高不同随访时间点的患者报告结果测量 （PROM） 评分。然而，分析患者性别对原发性 OCA 结果影响的研究仍然有限，并且显示出相互矛盾的结果。目的：比较接受膝关节原发性 OCA 的男性和女性患者在至少 5 年随访中的 PROM 评分和临床显着结果 （CSO） 实现率。研究设计：队列研究;证据水平，3.方法： 查询 2003 年 1 月至 2018 年 1 月期间接受原发性 OCA 的患者前瞻性收集的数据库，无论是否存在伴随手术。纳入标准包括 （1） 原发性 OCA，（2） 至少 5 年随访，以及 （3） OCA 时年龄 >18 岁。比较患者特征、术中变量、PROM 评分、再次手术和失败。在 5 年随访中，国际膝文献委员会 （IKDC） 评分、Lysholm 评分和膝关节损伤和骨关节炎结果评分 （KOOS） 比较了最小临床重要差异 （MCID） 、患者可接受症状状态 （PASS） 和实质性临床获益 （SCB） 的 CSO 达到率。进行回归分析以确定与实现 MCID 、 PASS 或 SCB 相关的因素。结果： 本研究共纳入 235 例患者 （119 例女性，116 例男性），平均年龄 31.0 ± 9.5 岁，平均随访 6.5 年，平均体重指数为 26.7 ± 4.2 kg/m 2。 男性患者的体重指数较高 （28.0 ± 4.3 vs 25.5 ± 3.8 kg/m 2;P < .001），较大的股骨内侧髁缺损 （分别为 20.2 ± 4.5 和 17.7 ± 3.5 mm;P < .001） 和较大的股骨外侧髁缺损 （分别为 20.3 ± 4.0 对 18.1 ± 3.1 mm;P = .002），并且更有可能同时接受截骨术 （分别为 24.1% 和 13.4%;P = .036），特别是伴随胫骨高位截骨术 （分别为 14.7% 和 3.4%;P = .002），与女性患者相比。基线时，男性患者的 IKDC 较高 （分别为 41.8 ± 15.1 vs 33.3 ± 15.2;P = .003）和 KOOS Sport（分别为 35.2 ± 24.1 对 25.1 ± 22.0;P = .032） 评分。在至少 5 年的随访中，女性患者的 Lysholm 水平较高 （分别为 79.6 ± 15.9 vs 73.8 ± 15.6;P = .026）和 KOOS 疼痛 （分别为 82.6 ± 16.9 对 79.1 ± 13.7;P = .049） 分数并达到 KOOS Sport 的 MCID（分别为 75.7% 和 46.7%;P = .015），KOOS 生活质量的 PASS（分别为 89.6% 和 67.3%;P = .003），以及 KOOS Sport 的 SCB（分别为 64.9% 和 23.3%;P < .001） 的比例高于男性患者。在多变量回归分析中，男性与达到 MCID 的几率降低相关（比值比，0.234 [95% CI，0.086-0.636];P = .004）和 SCB （比值比，0.433 [95% CI，0.205-0.917];P = .028） 的 IKDC 分数。37.9% 的患者再次手术，26.8% 的患者失败，男性和女性患者的发生率相当。 结论： 尽管男性患者的某些 PROM 术前评分较高，但女性患者在至少 5 年随访中，膝关节初次 OCA 后表现出更高或相当的术后 PROM 评分和 CSO 达标率。男性与 IKDC 评分达到 MCID 和 SCB 的几率降低显著相关。