Department of Orthopedics, CU Sports Medicine, University of Colorado School of Medicine, Boulder, Colorado, U.S.A..
Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
Arthroscopy. 2019 Jan;35(1):171-178. doi: 10.1016/j.arthro.2018.08.028.
To evaluate the current status of advanced cartilage restoration procedures among newly trained orthopaedic surgeons in the United States.
The American Board of Orthopaedic Surgery database was queried to identify all advanced cartilage restoration procedure cases submitted by American Board of Orthopaedic Surgery part II board certification examination candidates from 2003 to 2015. All documented autologous chondrocyte implantation, autologous osteochondral transfer, osteochondral allograft transplantation, and marrow stimulation techniques (MSTs) procedures were analyzed. Analysis was performed to describe trends in annual incidence, types of complications, concomitant procedures, and geographical differences in incidence of advanced cartilage procedures.
From 2003 to 2015, a total of 2,827 surgeons submitted 7,522 cartilage restoration procedures, with 7,060 cases documented as MST (80.01%). The number of cartilage cases decreased significantly from 2003 to in 2015 (P <.001), with MST having the largest decline (P < .001). The incidence of open osteochondral allograft transplantation (odds ratio = 1.35; P = .023) and open autologous osteochondral transfer (odds ratio = 0.84; P = .004) increased over the study period. Overall, the majority of patients (57.0%) were male; however, female patients were on average significantly older than male patients (P < .001). Cartilage procedures were performed concomitantly with a realignment osteotomy procedure in 1.7% of cases. The incidence of surgical complications increased throughout the study period from 2.9% in 2003 to 9.5% in 2015 (P < .001).
Cartilage restoration procedures, specifically MSTs, are being decreasingly performed among recently trained orthopaedic surgeons. In contrast, complication rates have been increasing since 2003, demonstrating a possible paradigm shift toward more complex cartilage procedures, specifically osteochondral grafting procedures.
This study demonstrates a significant decline in the use of MSTs by recently trained orthopaedic surgeons. In addition, an increase in several more complex cartilage restoration procedures was found. Taken in sum, these changes may reflect a shift in residency and fellowship training away from marrow stimulation procedures that elicit a fibrocartilage reparative tissue and toward more complex procedures that provide a more hyaline-like articular cartilage surface.
评估美国新培训的矫形外科医生中先进的软骨修复程序的现状。
查询美国矫形外科委员会数据库，以确定美国矫形外科委员会第 II 部分认证考试候选人从 2003 年至 2015 年提交的所有先进的软骨修复程序案例。对所有记录的自体软骨细胞植入、自体软骨骨软骨移植、同种异体骨软骨移植和骨髓刺激技术（MST）程序进行了分析。分析旨在描述先进的软骨手术年度发病率、并发症类型、伴随手术以及发病率的地域差异方面的趋势。
从 2003 年至 2015 年，共有 2827 名外科医生提交了 7522 例软骨修复程序，其中 7060 例记录为 MST（80.01%）。从 2003 年到 2015 年，软骨病例数明显减少（P <.001），其中 MST 降幅最大（P <.001）。开放性同种异体骨软骨移植（优势比=1.35；P=.023）和开放性自体软骨骨软骨移植（优势比=0.84；P=.004）的发生率在研究期间有所增加。总体而言，大多数患者（57.0%）为男性，但女性患者的平均年龄明显大于男性患者（P <.001）。软骨手术同时进行了 1.7%的重新排列截骨术。手术并发症的发生率在整个研究期间从 2003 年的 2.9%增加到 2015 年的 9.5%（P <.001）。
最近接受培训的矫形外科医生进行的软骨修复程序，特别是 MST 正在减少。相比之下，自 2003 年以来，并发症的发生率一直在增加，这表明可能正在向更复杂的软骨手术（特别是骨软骨移植手术）转变。
本研究表明，最近接受培训的矫形外科医生对 MST 的使用明显减少。此外，还发现了更多更复杂的软骨修复程序的增加。综上所述，这些变化可能反映了住院医师和专科医师培训从激发骨髓产生纤维软骨修复组织的刺激技术向提供更类似透明软骨关节表面的更复杂技术的转变。
