ATRC, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano,1/10, 40136, Bologna, Italy.
Knee Surg Sports Traumatol Arthrosc. 2019 Jun;27(6):1726-1738. doi: 10.1007/s00167-018-5316-5. Epub 2018 Dec 6.
Joint surface incongruence resulting from osteochondritis dissecans (OCD) alters the articular physiologic congruence, increasing the contact stress on adjacent joint surfaces and accelerating wear and the cascade of joint degeneration. Accordingly, the restoration of articular surface integrity is of major importance, especially in young adults where, in lesions left untreated or following simple fragment excision, early osteoarthritis can be anticipated. Therefore, the treatment algorithm in unstable knee OCD of the young adult foresees surgical options to restore the articular surface. Several procedures have been proposed, including refixation of the detached fragment bone marrow stimulation, osteochondral autograft implantation, fresh osteochondral allograft transplantation, and cell-based or cell-free regenerative techniques. The aim of this review was to summarize the evidence for these surgical strategies, reporting their results and limitations. The overall evidence documents positive results for each of the assorted surgical procedures applied to treat unstable OCD, thus indicating support for their selected use to treat osteochondral defects paying particular attention to their specific indications for the lesion characteristics. The fixation of a good quality fragment should be pursued as a first option, while unfixable small lesions may benefit from autografts. For large lesions, available cell-based or cell-free osteochondral scaffold are a feasible solution but with limitation in terms of regenerated tissue quality. In this light, fresh allografts may offer articular surface restoration with viable physiologic osteochondral tissue providing a predictably successful outcome, and therefore they may currently represent the most suitable option to treat unstable irreparable OCD lesion in young adults. LEVEL OF EVIDENCE: V.
由于剥脱性骨软骨炎（OCD）导致的关节表面不平整改变了关节的生理一致性，增加了相邻关节表面的接触应力，加速了磨损和关节退变的级联反应。因此，恢复关节表面的完整性非常重要，尤其是在年轻人中，未治疗或简单切除碎片后，可能会出现早期骨关节炎。因此，年轻成人不稳定膝关节 OCD 的治疗方案包括手术选择以恢复关节表面。已经提出了几种手术方法，包括固定游离的骨块、骨髓刺激、骨软骨自体移植、新鲜骨软骨同种异体移植以及基于细胞或无细胞的再生技术。本综述的目的是总结这些手术策略的证据，报告其结果和局限性。总体证据表明，每种用于治疗不稳定 OCD 的手术方法都有积极的结果，因此支持选择使用这些方法来治疗骨软骨缺损，特别注意其对病变特征的具体适应证。应首先追求固定质量良好的骨块，而无法固定的小病变可能受益于自体移植物。对于大的病变，现有的基于细胞或无细胞的骨软骨支架是一种可行的解决方案，但在再生组织质量方面存在局限性。在这方面，新鲜同种异体移植物可以提供具有生理活性骨软骨组织的关节表面恢复，提供可预测的成功结果，因此目前可能是治疗年轻成人不稳定不可修复 OCD 病变的最适用选择。证据级别：V。
