Solheim Eirik, Krokeide Arne Magnus, Melteig Peder, Larsen Allan, Strand Torbjørn, Brittberg Mats
Teres Bergen, Bergen, Norway.
Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
Knee Surg Sports Traumatol Arthrosc. 2016 May;24(5):1610-6. doi: 10.1007/s00167-014-3472-9. Epub 2014 Dec 13.
Focal chondral lesions of the knee are commonly occurring. A lot is known about their frequency, size and localisation in arthroscopic series, but less about the symptoms they elicit and little about how the arthroscopic findings and symptoms correlate. The purposes of the present study included to investigate the relationship between articular cartilage lesion factors and patient factors, and to compare the symptoms and function of cartilage lesion patients to those of patients with a deficient ACL.
A prospective registration was conducted of preoperative data including Lysholm knee score and perioperative findings in 1,000 consecutive patients undergoing an arthroscopic procedure of the knee-including microfracture of articular cartilage defects and ACL reconstructions.
Chondral or osteochondral lesions were found in 57 % of the arthroscopies. The mean Lysholm score in this subgroup was 55. The mean Lysholm score was significantly lower in women (50, SD 19) compared to men (59, SD 18, p < 0.001). Among the chondral lesion factors, only kissing (vs. non-kissing) lesions and multiple (vs. single) lesions influenced symptoms and function to a more than negligible degree. Microfracture in one or two articular cartilage defects was performed in 187 patients. The microfracture group had a significant lower mean Lysholm score (54, SD 18) than a group of patients (N = 71) undergoing ACL reconstruction group (67, SD 17, p < 0.001).
The study confirms that articular cartilage lesions are both common and cumbersome. Women seem to have more problems than men, whereas chondral lesion factors-such as localisation and size-seem to influence symptoms and function to a small degree. These aspects should be addressed when designing outcome studies, and should also be of interest to the orthopaedic surgeon-in the day-by-day clinical work. When treating these patients, our prime focus need to be on knee function rather than the cartilage defect as the relationship between the latter and the former is unclear.
Case-control study, Level III.
膝关节局灶性软骨损伤较为常见。在关节镜检查系列中，我们对其发生频率、大小和位置了解很多，但对其所引发的症状了解较少，且对关节镜检查结果与症状之间的关联也知之甚少。本研究的目的包括调查关节软骨损伤因素与患者因素之间的关系，并比较软骨损伤患者与前交叉韧带（ACL）缺陷患者的症状和功能。
对1000例连续接受膝关节镜手术（包括关节软骨缺损微骨折和ACL重建）患者的术前数据（包括Lysholm膝关节评分）和围手术期检查结果进行前瞻性记录。
在57%的关节镜检查中发现软骨或骨软骨损伤。该亚组的平均Lysholm评分为55分。女性的平均Lysholm评分（50分，标准差19）显著低于男性（59分，标准差18，p<0.001）。在软骨损伤因素中，只有“亲吻”（相对于“非亲吻”）损伤和多发（相对于单发）损伤对症状和功能的影响程度超过可忽略不计的程度。187例患者对一或两个关节软骨缺损进行了微骨折治疗。微骨折组的平均Lysholm评分（54分，标准差18）显著低于接受ACL重建的一组患者（N = 71）（67分，标准差17，p<0.001）。
该研究证实关节软骨损伤既常见又棘手。女性似乎比男性问题更多，而软骨损伤因素（如位置和大小）对症状和功能的影响程度似乎较小。在设计结果研究时应考虑这些方面，在日常临床工作中骨科医生也应予以关注。在治疗这些患者时，我们的主要关注点应是膝关节功能，而非软骨缺损，因为后者与前者之间的关系尚不清楚。
病例对照研究，III级。
