Department of Orthopaedic Surgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio.
Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California.
J Knee Surg. 2020 Dec;33(12):1187-1200. doi: 10.1055/s-0040-1721053. Epub 2020 Dec 1.
Large, focal articular cartilage defects of the knee (> 4 cm) can be a source of significant morbidity and often require surgical intervention. Patient- and lesion-specific factors must be identified when evaluating a patient with an articular cartilage defect. In the management of large cartilage defects, the two classically utilized cartilage restoration procedures are osteochondral allograft (OCA) transplantation and cell therapy, or autologous chondrocyte implantation (ACI). Alternative techniques that are available or currently in clinical trials include a hyaluronan-based scaffold plus bone marrow aspirate concentrate, a third-generation autologous chondrocyte implant, and an aragonite-based scaffold. In this review, we will focus on OCA and ACI as the mainstay in management of large chondral and osteochondral defects of the knee. We will discuss the techniques and associated clinical outcomes for each, while including a brief mention of alternative treatments. Overall, cartilage restoration techniques have yielded favorable clinical outcomes and can be successfully employed to treat these challenging large focal lesions.
膝关节大的、局灶性的关节软骨缺损（>4cm）可能是导致严重发病率的原因，通常需要手术干预。在评估患有关节软骨缺损的患者时，必须确定患者和病变的具体情况。在大的软骨缺损的治疗中，两种经典的软骨修复方法是骨软骨同种异体移植（OCA）和细胞治疗，或自体软骨细胞移植（ACI）。目前可用或正在临床试验中的替代技术包括基于透明质酸的支架加骨髓抽吸浓缩物、第三代自体软骨细胞植入物和基于方解石的支架。在这篇综述中，我们将重点介绍 OCA 和 ACI，因为它们是膝关节大的软骨和软骨下骨缺损的主要治疗方法。我们将讨论每种方法的技术和相关的临床结果，同时简要提及替代治疗方法。总的来说，软骨修复技术已经产生了良好的临床结果，可以成功地用于治疗这些具有挑战性的大的局灶性病变。
