Departments of *Orthopaedics; and †Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio; ‡Center for Orthopaedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas; and §Cartilage Restoration Program, The Sports Health and Performance Institute, OSU Sports Medicine, The Ohio State University, Columbus, Ohio.
Clin J Sport Med. 2014 Jan;24(1):21-30. doi: 10.1097/JSM.0000000000000004.
The purpose of this review is to survey the literature regarding factors used in determining a course of surgical treatment for symptomatic cartilage lesions of the knee to determine which factors affect treatment outcomes and should be incorporated in the treatment algorithm.
A systematic review was performed using PubMed, Cochrane Review, and SportDiscus databases for studies investigating factors affecting cartilage lesion treatment and outcomes. Inclusion criteria were clinical and basic science studies in English, on human or animal specimens that focus on factors affecting the initiation, progression, and treatment of focal knee chondral defects.
Twenty-seven studies examining 1450 human (1416 in vivo; 34 cadaveric) and 90 animal subjects met inclusion criteria. Female sex and higher body mass index (BMI) significantly predicted cartilage loss rates and recovery after microfracture (MFx) and autologous matrix-induced chondrogenesis. Defect size and location significantly predicted treatment outcomes. Sizes >2 to 4 cm demonstrated worse outcomes after MFx treatment. Defect size did not consistently affect autologous chondrocyte implantation or osteochondral autograft transplantation outcomes. Intra-articular lesion location was related to intralesional subchondral bone contact and MFx outcome. Corrected patellofemoral and tibiofemoral alignment improved clinical outcome when realignment procedures were done concurrently with cartilage repair.
Choice of the appropriate repair technique for focal knee cartilage defects is multifactorial. A treatment algorithm should consider frequently used factors such as defect size, location, knee alignment, and patient demand. However, patient sex and BMI could also be considered. Patient age was not significantly associated with clinical outcome.
本综述旨在调查膝关节症状性软骨损伤手术治疗方案中使用的各种因素，以确定哪些因素会影响治疗效果，应纳入治疗方案中。
使用 PubMed、Cochrane Review 和 SportDiscus 数据库，对探讨影响软骨病变治疗和结果的各种因素的临床和基础科学研究进行了系统性回顾。纳入标准为：以人类或动物标本为研究对象，以英文发表的关于影响膝关节局灶性软骨缺损起始、进展和治疗的各种因素的临床和基础科学研究。
共纳入 27 项研究，涉及 1450 例人类（1416 例体内；34 例尸体）和 90 例动物。女性和较高的体重指数（BMI）显著预测了微骨折（MFx）和自体基质诱导软骨形成术（ACI）后的软骨丢失率和恢复情况。缺损大小和位置显著预测了治疗效果。大小＞2 至 4cm 的缺损经 MFx 治疗后效果较差。缺损大小并不一致地影响 ACI 或骨软骨自体移植的效果。关节内病变位置与病灶内软骨下骨接触和 MFx 结果有关。当进行软骨修复的同时进行膝关节对线的矫正时，校正髌股和胫股对线可以改善临床效果。
膝关节局灶性软骨缺损的适当修复技术选择是多因素的。治疗方案应考虑到经常使用的因素，如缺损大小、位置、膝关节对线和患者需求。然而，患者的性别和 BMI 也可以被考虑。患者年龄与临床结果无显著相关性。
