Chahla Jorge, Hinckel Betina B, Yanke Adam B, Farr Jack, Bugbee William D, Carey James L, Cole Brian J, Crawford Dennis C, Fleischli James E, Getgood Alan, Gomoll Andreas H, Gortz Simon, Gross Allan E, Jones Deryk G, Krych Aaron J, Lattermann Christian, Mandelbaum Bert R, Mandt Peter R, Minas Tom, Mirzayan Raffy, Mologne Timothy S, Polousky John D, Provencher Matthew T, Rodeo Scott A, Safir Oleg, Sherman Seth Lawrence, Strauss Eric D, Strickland Sabrina M, Wahl Christopher J, Williams Riley J
Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA.
Orthop J Sports Med. 2020 Mar 26;8(3):2325967120907343. doi: 10.1177/2325967120907343. eCollection 2020 Mar.
Cartilage lesions of the patellofemoral joint constitute a frequent abnormality. Patellofemoral conditions are challenging to treat because of complex biomechanics and morphology.
To develop a consensus statement on the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint using a modified Delphi technique.
Consensus statement.
A working group of 4 persons generated a list of statements related to the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint to form the basis of an initial survey for rating by a group of experts. The Metrics of Osteochondral Allografts (MOCA) expert group (composed of 28 high-volume cartilage experts) was surveyed on 3 occasions to establish a consensus on the statements. In addition to assessing agreement for each included statement, experts were invited to propose additional statements for inclusion or to suggest modifications of existing statements with each round. Predefined criteria were used to refine statement lists after each survey round. Statements reaching a consensus in round 3 were included within the final consensus document.
A total of 28 experts (100% response rate) completed 3 rounds of surveys. After 3 rounds, 36 statements achieved a consensus, with over 75% agreement and less than 20% disagreement. A consensus was reached in 100.00% of the statements relating to functional anatomy of the patellofemoral joint, 88.24% relating to surgical indications, 100.00% relating to surgical technical aspects, and 100.00% relating to rehabilitation, with an overall consensus of 95.5%.
This study established a strong expert consensus document relating to the functional anatomy, surgical indications, donor graft considerations for osteochondral allografts, surgical technical aspects, and rehabilitation concepts for the management of large chondral and osteochondral defects in the patellofemoral joint. Further research is required to clinically validate the established consensus statements and better understand the precise indications for surgery as well as which techniques and graft processing/preparation methods should be used based on patient- and lesion-specific factors.
髌股关节软骨损伤是一种常见的异常情况。由于生物力学和形态学复杂，髌股疾病的治疗具有挑战性。
采用改良德尔菲技术，就髌股关节大的软骨和骨软骨缺损的功能解剖、适应证、供体移植物考量、手术治疗及康复制定一份共识声明。
共识声明。
一个由4人组成的工作组列出了一系列与髌股关节大的软骨和骨软骨缺损的功能解剖、适应证、供体移植物考量、手术治疗及康复相关的声明，作为由一组专家进行评分的初始调查的基础。对骨软骨异体移植指标（MOCA）专家组（由28位大量开展软骨手术的专家组成）进行了3次调查，以就这些声明达成共识。除了评估每份纳入声明的一致性外，还邀请专家在每一轮中提出其他纳入声明或对现有声明提出修改建议。在每一轮调查后，使用预定义标准完善声明列表。在第3轮达成共识的声明被纳入最终的共识文件。
共有28位专家（回复率100%）完成了3轮调查。三轮过后，36条声明达成了共识，同意率超过75%，不同意率低于20%。与髌股关节功能解剖相关的声明达成共识的比例为100.00%，与手术适应证相关的为88.24%，与手术技术方面相关的为100.00%，与康复相关的为100.00%，总体共识率为95.5%。
本研究建立了一份强有力的专家共识文件，内容涉及髌股关节大的软骨和骨软骨缺损的功能解剖、手术适应证、骨软骨异体移植物的供体移植物考量、手术技术方面及康复理念。需要进一步研究以临床验证已确立的共识声明，并更好地理解手术的确切适应证，以及基于患者和病变特定因素应使用哪些技术和移植物处理/制备方法。
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