Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, Ohio 45242, USA.
Arthroscopy. 2013 Aug;29(8):1423-36. doi: 10.1016/j.arthro.2013.03.077. Epub 2013 May 24.
The purpose of this review was to determine if there is an ideal operation for large symptomatic articular cartilage lesions on the undersurface of the patella in young patients.
A systematic search of PubMed was conducted to determine the outcome of operations performed for large patellar lesions in young patients. Inclusionary criteria were English language, original clinical trials published from 1992 to 2012, patellar lesions 4 cm(2) or larger, mean patient age 50 years or younger, and all evidence levels.
Of 991 articles identified, 18 met the inclusionary criteria, encompassing 840 knees in 828 patients. These included 613 knees that underwent autologous chondrocyte implantation (ACI) (11 studies), 193 knees that had patellofemoral arthroplasty (PFA) (5 studies), and 34 knees that underwent osteochondral allografting (OA) (2 studies). The mean patient age was 37.2 years and the mean follow-up was 6.2 years. Long-term follow-up (>10 years) was available in only 4 studies (2 PFA, 1 ACI, 1 OA). All studies except one were Level IV and none were randomized or had a control group. Twenty-one outcome instruments were used to determine knee function. When taking into account knees that either failed or had fair/poor function, the percentage of patients who failed to achieve a benefit averaged 22% after PFA and 53% after OA and ranged from 8% to 60% after ACI. In addition, all 3 procedures had unacceptable complication and reoperation rates.
The combination of failure rates and fair/poor results indicated that all 3 procedures had unpredictable results. We concluded that a long-term beneficial effect might not occur in one of 3 ACI and PFA procedures and in 2 of 3 OA procedures. We were unable to determine an ideal surgical procedure to treat large symptomatic patellar lesions in patients 50 years or younger.
Level IV, systematic review of Level I to IV studies.
本综述旨在确定对于年轻患者髌下大的关节软骨病变，是否存在理想的手术治疗方法。
通过系统检索 PubMed，确定了 1992 年至 2012 年间发表的针对年轻患者髌下大病变的手术治疗结果。纳入标准为英文文献、原始临床试验、病变面积大于或等于 4cm2、患者平均年龄 50 岁及以下、所有证据水平。
共检索到 991 篇文章，18 篇符合纳入标准，共纳入 828 例患者的 840 膝。其中包括 613 例接受自体软骨细胞移植（ACI）（11 项研究）、193 例接受髌股关节成形术（PFA）（5 项研究）和 34 例接受骨软骨同种异体移植（OA）（2 项研究）。患者平均年龄为 37.2 岁，平均随访时间为 6.2 年。仅有 4 项研究（2 项 PFA、1 项 ACI、1 项 OA）提供了超过 10 年的长期随访结果。所有研究均为 IV 级，均未随机分组或设立对照组。21 种膝关节功能评估工具用于评估膝关节功能。考虑到手术失败或膝关节功能一般/较差的患者，PFA 后有 22%的患者未获得获益，OA 后有 53%的患者未获得获益，ACI 后有 8%至 60%的患者未获得获益。此外，所有 3 种手术均有不可接受的并发症和再手术率。
失败率和一般/较差结果的综合表明，所有 3 种手术的效果均不可预测。我们得出结论，在 3 种 ACI 和 PFA 手术中，有 1 种手术和 3 种 OA 手术中的 2 种手术可能不会产生长期有益效果。我们无法确定治疗 50 岁及以下患者大的、有症状的髌下病变的理想手术方法。
IV 级，对 I 级至 IV 级研究的系统评价。
