Thessaloniki Minimally Invasive Surgery (TheMIS) Orthopaedic Center, St. Luke's Hospital, 55236, Thessaloniki, Greece.
Thessaloniki Minimally Invasive Surgery (TheMIS) Orthopaedic Center, St. Luke's Hospital, 55236, Thessaloniki, Greece; Department of Traumatology, Hospital Periférico de Coche, Intercomunal avenue at Zea street, 1090, Coche, Caracas, Venezuela.
Surgeon. 2021 Dec;19(6):356-364. doi: 10.1016/j.surge.2020.11.011. Epub 2021 Jan 8.
Arthroscopic debridement, the most commonly applied surgical technique for focal cartilage lesions in the knee, is not included in most treatment algorithms because of discouraging results in the management of osteoarthritis of the knee. The present systematic review evaluates the outcome of arthroscopic cartilage debridement as the primary treatment of focal knee chondral lesions in adults, and defines its indications and role as the primary treatment of focal knee chondral lesions.
Two independent investigators searched PubMed, Cochrane CENTRAL, and Virtual Health Library databases using the terms "knee", "cartilage", "chondral", "lesions", "injury", "damage", "debridement", "chondroplasty", "chondrectomy", alone and in combination. Clinical studies evaluating the effect of mechanical cartilage debridement in adults with symptomatic focal cartilage lesions in the knee joint regardless of the defect size and depth were included. We excluded studies if patients had a concomitant ligament or meniscus injury, and/or had additional debridement with monopolar radiofrequency energy.
Available studies suggest good to excellent short and medium-term functional outcomes (KOOS, LKSS, Tegner scale) for focal cartilage lesions treated with debridement regardless of the defect size and depth. Data are lacking comparing cartilage debridement versus other cartilage repair techniques.
Arthroscopic debridement of focal articular cartilage lesions of the knee is associated with good to excellent short and medium-term postoperative outcomes, especially in terms of functional improvement. Arthroscopic debridement may be considered in the primary treatment of focal cartilage injuries regardless of the defect size and depth. However, available studies are limited and the level of evidence is low.
关节镜下清创术是治疗膝关节局灶性软骨病变最常用的手术技术，但由于对膝关节骨关节炎的治疗效果不佳，大多数治疗方案并未将其纳入。本系统评价评估了关节镜下软骨清创术作为成人膝关节局灶性软骨病变的主要治疗方法的疗效，并确定了其作为成人膝关节局灶性软骨病变的主要治疗方法的适应证和作用。
两位独立的研究者使用“膝关节”、“软骨”、“软骨下”、“病变”、“损伤”、“损伤”、“清创术”、“软骨成形术”、“软骨切除术”等术语，在 PubMed、Cochrane 中心数据库和虚拟卫生图书馆数据库中进行了独立搜索。纳入了评估机械性软骨清创术对膝关节有症状的局灶性软骨病变患者（无论病变大小和深度如何）疗效的临床研究。如果患者伴有韧带或半月板损伤，和/或进行了额外的单极射频能量清创术，则排除这些研究。
现有的研究表明，无论病变大小和深度如何，采用清创术治疗的局灶性软骨病变患者的短期和中期功能结局（KOOS、LKSS、Tegner 量表）均较好至优秀。目前缺乏比较软骨清创术与其他软骨修复技术的研究数据。
膝关节局灶性关节软骨病变的关节镜下清创术与良好至优秀的短期和中期术后结局相关，尤其是在功能改善方面。无论病变大小和深度如何，关节镜下清创术都可以作为局灶性软骨损伤的主要治疗方法。但是，现有的研究有限，证据水平较低。
