足と足首の臨床研究

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A Retrospective Comparison of Clinical and Patient-Reported Outcomes in Foot and Ankle Arthrodesis Procedures Using Two Cellular Bone Allografts

Roukis TS, Wetzell B, McLean JB, Dorsch K, Moore MA

Objective: The purpose of this retrospective study was to compare clinical and patient-reported outcomes following foot and ankle arthrodesis (FAA) procedures using two cellular bone allografts containing viable lineagecommitted bone forming cells (V-CBA) versus mesenchymal stem cells (T-CBA), each within an osteoconductive matrix mixed with demineralized bone. Methods: A total of 47 consecutive patients underwent foot and ankle arthrodesis procedures: 31 patients received V-CBA and 16 patients received T-CBA. Baseline characteristics were summarized. Clinical (rates of ankle and subtalar [when applicable] fusion at 6 months and rates of complications) and patient-reported outcomes (satisfaction, and pre- and postsurgical visual analog scale [VAS] for pain) were compared between the two grafts. Results: The use of V-CBA led to significantly higher rates of ankle fusion at 6 months (100% vs. 50.00%; P<0.0001), equitable subtalar fusion rates (89.29% vs 71.43%, ns), and significantly fewer complications (6.45% vs 62.50%; P<0.0001), in spite of patient comorbidities and lifestyle characteristics that would be expected to negatively affect such outcomes. Additionally, all of the patients who received V-CBA were satisfied with their postsurgical outcomes (versus a significantly lower 68.75% in the T-CBA group; P=0.0028), and they reported a significantly lower average postsurgical VAS of 1.40 points (a reduction of 7.52 points from presurgical), compared with 3.15 points in the T-CBA group (4.84-point reduction; P=0.0099). Conclusion: Clinical and patient-reported outcomes were significantly improved following the use of V-CBA versus T-CBA, except for subtalar fusion rates, which were equitable. The results of this study support preclinical findings suggesting that viable lineage-committed bone cells may be a more suitable choice for enhancing bone fusion compared to MSCs, and suggest that V-CBA in FAA procedures can result in early fusion with minimal complications, less influence from relevant comorbidities and lifestyle risks, and more successful clinical and patientreported outcomes.