Lynch T Sean, Patel Ronak M, Benedick Alex, Amin Nirav H, Jones Morgan H, Miniaci Anthony
Department of Orthopaedic Surgery, Division of Sports Medicine, Cleveland Clinic Sports Health, Cleveland, Ohio, U.S.A..
Department of Orthopaedic Surgery, Division of Sports Medicine, Cleveland Clinic Sports Health, Cleveland, Ohio, U.S.A.
Arthroscopy. 2015 Apr;31(4):746-54. doi: 10.1016/j.arthro.2014.11.018. Epub 2015 Jan 21.
The goal of this systematic review was to present the current best evidence for clinical outcomes of osteochondral autograft transplantation to elucidate the efficacy of this procedure.
PubMed, CINAHL, and the Cochrane Central Register of Controlled Trials were searched (key terms "knee," "osteochondral autograft transfer," or "mosaicplasty") to identify relevant literature between 1950 and 2013 in the English language. This evaluation included studies in pediatric and adult patients with grade 3 or 4 articular cartilage injuries; the studies had a minimum of 25 patients and at least 12 months of follow-up and compared osteochondral autograft transfers/mosiacplasty with another treatment modality. Articles were limited to full-text randomized controlled trials or cohort studies. Main outcomes studied were patient-reported and functional outcome, with secondary outcomes including effect of lesion size, return to sport and sport function, radiographic outcomes, and reoperation rates.
There were a total of 9 studies with 607 patients studied in this systematic review. When osteochondral autologous transfer/mosaicplasty (OATM) was compared with microfracture (MF), patients with OATM had better clinical results, with a higher rate of return to sport and maintenance of their sports function from before surgery. Meanwhile, patients who underwent MF trended toward more reoperations, with deterioration around 4 years after surgery. When compared with autologous chondrocyte implantation (ACI), clinical outcome improvement was not conclusive; however, at 10-year follow-up, a greater failure rate was found to be present in the OATM group.
Current evidence shows improved clinical outcomes with OATM when compared with preoperative conditions. These patients were able to return to sport as early as 6 months after the procedure. It could be suggested from the data that OATM procedures might be more appropriate for lesions that are smaller than 2 cm(2) with the known risk of failure between 2 and 4 years. Further high-quality prospective studies into the management of these articular cartilage injuries are necessary to provide a better framework within which to target intervention.
Level II, systematic review of Level I and II studies.
本系统评价的目的是提供自体骨软骨移植临床结局的当前最佳证据，以阐明该手术的疗效。
检索了PubMed、CINAHL和Cochrane对照试验中央注册库（关键词为“膝关节”“自体骨软骨移植”或“马赛克成形术”），以识别1950年至2013年间的英文相关文献。该评价纳入了患有3级或4级关节软骨损伤的儿科和成年患者的研究；这些研究至少有25名患者且至少随访12个月，并将自体骨软骨移植/马赛克成形术与另一种治疗方式进行了比较。文章限于全文随机对照试验或队列研究。研究的主要结局是患者报告的结局和功能结局，次要结局包括损伤大小的影响、恢复运动和运动功能、影像学结局以及再次手术率。
本系统评价共纳入9项研究，涉及607例患者。当将自体骨软骨移植/马赛克成形术（OATM）与微骨折术（MF）进行比较时，接受OATM的患者临床结果更好，恢复运动的比例更高，且运动功能维持在术前水平。同时，接受MF的患者再次手术的趋势更大，术后约4年情况恶化。与自体软骨细胞植入（ACI）相比，临床结局改善并不确定；然而，在10年随访时，OATM组的失败率更高。
当前证据表明，与术前情况相比，OATM的临床结局有所改善。这些患者在手术后6个月即可尽早恢复运动。从数据中可以看出，OATM手术可能更适合小于2 cm²的损伤，已知其在2至4年之间存在失败风险。有必要对这些关节软骨损伤的治疗进行进一步的高质量前瞻性研究，以提供更好的干预目标框架。
II级，对I级和II级研究的系统评价。
