Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.
Knee Surg Sports Traumatol Arthrosc. 2019 Mar;27(3):854-867. doi: 10.1007/s00167-018-5139-4. Epub 2018 Sep 19.
The patellofemoral (PF) joint contains the thickest articular cartilage in the human body. Chondral lesions to this area are often misdiagnosed and can predispose to secondary osteoarthritis if left untreated. Treatment options range from arthroscopic debridement to cartilage restoration techniques such as microfracture (MFx), autologous chondrocyte implantation (ACI), and osteochondral autograft transplantation. The purpose of this study was to systematically assess the trends in surgical techniques, outcomes, and complications of cartilage restoration of the PF joint.
This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The electronic databases PubMed, MEDLINE, and EMBASE were searched from January 1, 2007 to April 30, 2018. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. A two-proportion z test was used to determine whether the differences between the proportions of cartilage restoration techniques used from 2007 to 2012 and 2013-2018 were statistically significant.
Overall, 28 studies were identified, including 708 patients (824 knees) with a mean age of 39.5 ± 10.5 years and a mean follow-up of 39.1 ± 16.0 months. Majority of patients were treated with ACI (45.5%) and MFx (29.6%). A significant increase in the use of the third generation ACI occurred with a simultaneous decreased usage of the conventional MFx over the last 5 years (p < 0.001). All techniques had significant (p < 0.05) improvements in clinical outcomes. The overall complication rate was 9.2%, of which graft hypertrophy (2.7%) was the most prevalent.
ACI was the most common restoration technique. The use of third generation ACI has increased with a concurrent decline in the use of conventional MFx over the latter half of the past decade (p < 0.001). Overall, the various cartilage restoration techniques reported improvements in patient reported outcomes with low complication rates. Definitive conclusions on the optimal treatment remain elusive due to a lack of high-quality comparative studies.
Level IV, Systematic Review of Level-II-IV studies.
髌股（PF）关节包含人体最厚的关节软骨。如果不及时治疗，该区域的软骨损伤经常被误诊，并可能导致继发性骨关节炎。治疗方法包括关节镜下清理术以及软骨修复技术，如微骨折（MFx）、自体软骨细胞移植（ACI）和骨软骨自体移植。本研究旨在系统评估 PF 关节软骨修复的手术技术、结果和并发症的趋势。
本综述根据系统评价和荟萃分析的首选报告项目（PRISMA）的指南进行。从 2007 年 1 月 1 日至 2018 年 4 月 30 日，对 PubMed、MEDLINE 和 EMBASE 电子数据库进行了搜索。采用非随机研究方法学指数（MINORS）评估研究质量。采用双比例 z 检验确定 2007 年至 2012 年和 2013-2018 年使用的软骨修复技术比例的差异是否具有统计学意义。
总体而言，共确定了 28 项研究，包括 708 例患者（824 膝），平均年龄为 39.5±10.5 岁，平均随访 39.1±16.0 个月。大多数患者接受了 ACI（45.5%）和 MFx（29.6%）治疗。过去 5 年中，第三代 ACI 的应用显著增加，同时传统 MFx 的应用减少（p<0.001）。所有技术的临床结果均有显著改善（p<0.05）。总体并发症发生率为 9.2%，其中移植物肥大（2.7%）最为常见。
ACI 是最常见的修复技术。在过去十年的后半段，第三代 ACI 的应用增加，而传统 MFx 的应用减少（p<0.001）。总体而言，各种软骨修复技术报告患者报告结果改善，并发症发生率低。由于缺乏高质量的对照研究，因此仍然难以确定最佳治疗方法。
四级，二级至四级研究的系统评价。
