Weber Christian D, Migliorini Filippo, Hildebrand Frank
Department of Trauma and Reconstructive Surgery, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany.
Department of Orthopaedics and Trauma Surgery, RWTH Aachen University, 52074 Aachen, Germany.
Life (Basel). 2021 Jun 10;11(6):543. doi: 10.3390/life11060543.
Large (>3 cm), focal osteochondral lesions (OCL) may result in poor functional outcomes and early secondary osteoarthritis of the knee. The surgical management of these OCL remains challenging. The treatment strategy must be tailored to various aspects, including lesion-specific (e.g., size, location, chronicity), joint-specific (e.g., instability, limb alignment, meniscal status), and patient-specific factors (e.g., age, activity level, comorbidities). Simple chondroplasty and bone marrow stimulation (BMS) techniques should be reserved for smaller lesions, as they only realize midterm clinical benefits, related to inferior wear characteristics of the induced fibrocartilage (type I collagen). Therefore, much attention has been focused on surgical restoration with hyaline cartilage (type II collagen), based on chondrocyte transplantation and matrix-assisted autologous chondrocyte implantation (MACI). Limited graft availability, staged procedures (MACI), and high treatment costs are limitations of these techniques. However, acute traumatic OCL of the femoral condyles and patellofemoral joint may also be suitable for preservation by surgical fixation. Early detection of the fragment facilitates primary repair with internal fixation. The surgical repair of the articular surface may offer promising clinical and cost-effective benefits as a first-line therapy but remains under-investigated and potentially under-utilized. As a unique characteristic, the fixation technique allows the anatomic restoration of the hyaline articular surface with native cartilage and the repair of the subchondral bone. In this manuscript, we present a case series of large OCL around the knee that were preserved by surgical fixation. Furthermore, various implants and techniques reported for this procedure are reviewed.
较大（>3厘米）的局灶性骨软骨损伤（OCL）可能导致膝关节功能预后不良和早期继发性骨关节炎。这些OCL的手术治疗仍然具有挑战性。治疗策略必须根据多个方面进行调整，包括损伤特异性因素（如大小、位置、病程）、关节特异性因素（如不稳定、肢体对线、半月板状态）以及患者特异性因素（如年龄、活动水平、合并症）。简单的软骨成形术和骨髓刺激（BMS）技术应仅用于较小的损伤，因为它们仅能实现中期临床益处，这与诱导的纤维软骨（I型胶原）较差的磨损特性有关。因此，基于软骨细胞移植和基质辅助自体软骨细胞植入（MACI）的透明软骨（II型胶原）手术修复受到了广泛关注。这些技术存在移植物供应有限、分阶段手术（MACI）以及治疗成本高等局限性。然而，股骨髁和髌股关节的急性创伤性OCL也可能适合通过手术固定进行保留。碎片的早期检测有助于通过内固定进行一期修复。关节面的手术修复作为一线治疗可能会带来有前景的临床和成本效益，但仍未得到充分研究且可能未得到充分利用。作为一个独特的特点，固定技术能够使透明关节面与天然软骨进行解剖复位，并修复软骨下骨。在本手稿中，我们展示了一系列通过手术固定得以保留的膝关节周围大型OCL病例。此外，还对该手术报道的各种植入物和技术进行了综述。
