Campbell Andrew B, Pineda Miguel, Harris Joshua D, Flanigan David C
The Ohio State University Division of Sports Medicine Cartilage Repair Center, Department of Orthopedics, Columbus, Ohio, U.S.A.
Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A.
Arthroscopy. 2016 Apr;32(4):651-68.e1. doi: 10.1016/j.arthro.2015.08.028. Epub 2015 Oct 30.
To perform a systematic review of cartilage repair in athletes' knees to (1) determine which (if any) of the most commonly implemented surgical techniques help athletes return to competition, (2) identify which patient- or defect-specific characteristics significantly affect return to sport, and (3) evaluate the methodologic quality of available literature.
A systematic review of multiple databases was performed. Return to preinjury level of sport was defined as the ability to play in the same or greater level (i.e., league or division) of competition after surgery. Study methodologic quality for all studies analyzed in this review was evaluated with the Coleman Methodology Score.
Systematic review of 1,278 abstracts identified 20 level I-IV studies for inclusion but only 1 randomized controlled trial. Twenty studies (1,117 subjects) were included. Subjects (n = 970) underwent 1 of 4 surgeries (microfracture [n = 529], autologous chondrocyte implantation [ACI, n = 259], osteochondral autograft [n = 139], or osteochondral allograft [n = 43]), and 147 were control patients. The rate of return to sports was greatest after osteochondral autograft transplantation (89%) followed by osteochondral allograft, ACI, and microfracture (88%, 84%, and 75%, respectively). Osteochondral autograft transplantation and ACI had statistically significantly greater rates of return to sports compared with microfracture (P < .001, P < .01; Fisher exact test).
Athletes may return to sports participation after microfracture, ACI, osteochondral autograft, or osteochondral allograft, but microfracture patients were least likely to return to sports. The athletes who had a better prognosis after surgery were younger, had a shorter preoperative duration of symptoms, underwent no previous surgical interventions, participated in a more rigorous rehabilitation protocol, and had smaller cartilage defects.
Level IV, systematic review of Level I-IV studies.
对运动员膝关节软骨修复进行系统评价，以（1）确定最常用的手术技术中哪些（如果有的话）有助于运动员恢复比赛，（2）确定哪些患者或缺损特异性特征显著影响恢复运动的情况，以及（3）评估现有文献的方法学质量。
对多个数据库进行系统评价。恢复到伤前运动水平定义为术后能够参加相同或更高水平（即联赛或分区）比赛的能力。本评价中分析的所有研究的研究方法学质量采用科尔曼方法学评分进行评估。
对127,8篇摘要进行系统评价，确定纳入20项I-IV级研究，但仅有1项随机对照试验。纳入20项研究（1117名受试者）。受试者（n = 970）接受了4种手术中的1种（微骨折术[n = 529]、自体软骨细胞移植术[ACI，n = 259]、自体骨软骨移植术[n = 139]或异体骨软骨移植术[n = 43]），147名是对照患者。自体骨软骨移植术后恢复运动的比例最高（89%），其次是异体骨软骨移植术、ACI和微骨折术（分别为88%、84%和75%）。与微骨折术相比，自体骨软骨移植术和ACI恢复运动的比例在统计学上显著更高（P < .001，P < .01；Fisher精确检验）。
运动员在接受微骨折术、ACI、自体骨软骨移植术或异体骨软骨移植术后可能恢复运动参与，但微骨折术患者恢复运动的可能性最小。术后预后较好的运动员年龄较小、术前症状持续时间较短、既往未接受过手术干预、参与了更严格的康复方案且软骨缺损较小。
IV级，I-IV级研究的系统评价。
