Haien Zhao, Jiachang Wu, Qiang Li, Yufeng Mei, Zhenwei Ji
High-Tech Institute of Xi'an, Xi'an, Shaanxi, China.
Orthopedic Department, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
J Knee Surg. 2018 Apr;31(4):341-347. doi: 10.1055/s-0037-1603798. Epub 2017 Jun 23.
Various techniques have proven to be effective for treating articular cartilage defect of the knee joint, but knowledge regarding which method is best still remains uncertain. Osteochondral autologous transplantation (OAT) provides hyaline or hyaline-like repair for articular defects, whereas microfracture (MF) provides fibrocartilage repair tissue. To compare the OAT with MF procedure for the treatment of articular cartilage defect, we present an update of previous meta-analysis of randomized controlled trials.We searched for the published results of relevant trials. Then, we pooled the outcome measures of the included trials for analysis. The outcome measures assessed in this study included the number of patients who reached excellent or good results, the patients returning to the activity, the International Cartilage Repair Society (ICRS) scores, the failure rate, and the osteoarthritis rate. Six studies and 294 patients were identified as eligible for data extraction and meta-analysis. The pooled result showed that there was no significant difference in the excellent or good results (relative risks [RRs], 1.27; 95% confidence intervals [CIs], 0.95 to 1.70; = 0.11) and the rate of osteoarthritis (RRs, 0.64; 95% CIs, 0.37 to 1.13; = 0.12). There were significant differences between the two groups in the scores of ICRS (mean differences [MDs], 12.51; 95% CIs, 10.55 to 14.47; = 0.00001), the patients returning to activity (RRs, 2.04; 95% CIs, 1.36 to 3.07; = 0.0006), and in the failure rate (RRs, 0.23; 95% CIs, 0.11 to 0.49; = 0.0001). OAT has more advantages compared with MF procedure in referring to the index of return to activity, the scores of ICRS, and the rate of failure. However, the limitations restrict the generalizability of this study, and larger, sufficiently powered studies are necessary to evaluate the efficiency of OAT compared with MF procedure in the future.
各种技术已被证明对治疗膝关节软骨缺损有效，但关于哪种方法最佳的认识仍不明确。自体骨软骨移植（OAT）可为关节缺损提供透明软骨或类似透明软骨的修复，而微骨折术（MF）则提供纤维软骨修复组织。为比较OAT与MF治疗关节软骨缺损的效果，我们对之前关于随机对照试验的荟萃分析进行了更新。我们检索了相关试验的已发表结果。然后，我们汇总纳入试验的结局指标进行分析。本研究评估的结局指标包括达到优或良结果的患者数量、恢复活动的患者、国际软骨修复协会（ICRS）评分、失败率和骨关节炎发生率。六项研究及294例患者被确定符合数据提取和荟萃分析的条件。汇总结果显示，在优或良结果（相对危险度[RRs]，1.27；95%可信区间[CIs]，0.95至1.70；P = 0.11）和骨关节炎发生率（RRs，0.64；95% CIs，0.37至1.13；P = 0.12）方面无显著差异。两组在ICRS评分（平均差[MDs]，12.51；95% CIs，10.55至14.47；P = 0.00001）、恢复活动的患者（RRs，2.04；95% CIs，1.36至3.07；P = 0.0006）以及失败率（RRs，0.23；95% CIs，0.11至0.49；P = 0.0001）方面存在显著差异。在恢复活动指标、ICRS评分和失败率方面，OAT与MF相比具有更多优势。然而，这些局限性限制了本研究的普遍性，未来需要更大规模、有足够效力的研究来评估OAT与MF相比的有效性。
