Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taiwan, ROC.
Department of Orthopedics, Hualien Armed Force Hospital, Taiwan, ROC; Department of Life Science and the institute of Biotechnology, National Dong Hwa University, Taiwan, ROC.
Arthroscopy. 2020 Jan;36(1):289-303. doi: 10.1016/j.arthro.2019.06.033. Epub 2019 Nov 7.
To compare clinical outcomes among patients with fractures of knee cartilage who were treated with autologous chondrocyte implantation (ACI) or microfracture (MF).
A systematic review was made of randomized controlled trials of articular cartilage lesions of the knee treated with ACI or MF that were published between January 2000 and November 2018 and catalogued in 4 major databases. The outcomes of clinical score, quality of life (QoL), pain relief score, and failure rate were assessed.
A final group of 12 randomized controlled trials were included that enrolled a total of 659 patients with knee cartilage lesions: 332 patients had received ACI and 327 patients had undergone MF. Patients ranged in age from 25 to 41 years, and the majority were male. Lesion size ranged from 2.3 to 10.0 cm. Pooled analysis found no significant difference in the improvement in International Knee Documentation Committee and Lysholm scores or overall Knee Injury and Osteoarthritis Outcome Score measures between patients in the ACI and MF groups at 1-year, 2-year, and 5-year follow-up examinations or in failure rate at 2-year, 3-year, and 5-year follow-up timepoints. However, patients treated with ACI had a significant benefit in activities of daily living at follow-up of 5 years or less compared with patients treated with MF. ACI treatment also showed better improvement in QoL and pain relief than MF at 5-year and 2-year follow-up examinations, respectively.
The pooled analysis found no significant difference in the improvement in International Knee Documentation Committee or Lysholm scores or overall Knee Injury and Osteoarthritis Outcome Score measures between patients in the ACI and MF groups at 1 to 5 years of follow-up. Patients treated with ACI may have a significant benefit in activities of daily living, QoL, and pain relief compared with patients treated with MF, although clinical relevance may not be achieved.
Level II, systematic review of Level I and II investigations.
比较采用自体软骨细胞移植（ACI）或微骨折（MF）治疗膝关节软骨骨折患者的临床结果。
对 2000 年 1 月至 2018 年 11 月期间在 4 个主要数据库中发表的 ACI 或 MF 治疗膝关节关节软骨病变的随机对照试验进行了系统评价，并进行了编目。评估了临床评分、生活质量（QoL）、疼痛缓解评分和失败率的结果。
最终纳入 12 项随机对照试验，共纳入 659 例膝关节软骨病变患者：332 例接受 ACI 治疗，327 例接受 MF 治疗。患者年龄 25-41 岁，多数为男性。病变大小 2.3-10.0cm。汇总分析发现，在 1 年、2 年和 5 年随访检查时，ACI 和 MF 组患者的国际膝关节文献委员会和 Lysholm 评分或整体膝关节损伤和骨关节炎结局评分的改善，以及 2 年、3 年和 5 年随访时间点的失败率，无显著差异。然而，在 5 年及以下随访时，接受 ACI 治疗的患者在日常生活活动方面的获益明显优于接受 MF 治疗的患者。ACI 治疗在 5 年和 2 年随访检查时在 QoL 和疼痛缓解方面的改善也优于 MF。
汇总分析发现，在 1 至 5 年随访时，ACI 和 MF 组患者的国际膝关节文献委员会或 Lysholm 评分或整体膝关节损伤和骨关节炎结局评分的改善无显著差异。与接受 MF 治疗的患者相比，接受 ACI 治疗的患者在日常生活活动、QoL 和疼痛缓解方面可能具有显著获益，尽管可能无法达到临床相关性。
二级，对一级和二级研究的系统评价。
