Jagtenberg Eline M, Kalmet Pishtiwan H S, de Krom Maartje A P, Hermus Joris P S, Seelen Henk A M, Poeze Martijn
Maastricht University Medical Centre, Dept. of Trauma Surgery, Maastricht, the Netherlands.
Maastricht University Medical Centre, Dept. of Orthopedic Surgery, Maastricht, the Netherlands.
J Orthop. 2021 Aug 17;27:34-40. doi: 10.1016/j.jor.2021.08.011. eCollection 2021 Sep-Oct.
Osteochondral lesions of the tibial plafond (OLTPs) occur less frequently than those of the talus, and treatment guidelines have not been determined. The aim of the current review was to evaluate the effectiveness of surgical treatments on the healing of cartilage and on function level, i.e. pain reduction, reduced swelling and improved joint range of motion, in patients with OLTPs.
A comprehensive literature search in PubMed/MEDLINE, Cochrane Database of Systematic Reviews and Google Scholar was performed up to December 2020. The outcome measures were healing of cartilage and function level.
Four studies investigating treatment of OLTPs were included. Three studies investigated treatment by means of microfracture. One of these studies showed an osteochondral defect filling in 52.0% of patients. All three studies showed an improvement in function level. Antegrade drilling was evaluated in one study, showing contrasting results in two patients. One-step bone marrow-derived cell transplantation was evaluated in one study, showing an osteochondral defect filling in 68.0% of patients and improvements in patients' function level.
Arthroscopic treatment of OLTPs by means of microfracture and bone marrow-derived cell transplantation (BMDCT) seem effective for the outcome at the patient's function level, while BMDCT showed more promising results regarding defect filling. However, this is based on the current available evidence with poor quality of methodology. Further research is of paramount importance to understand this injury and to evaluate the best treatments.
胫骨平台骨软骨损伤（OLTPs）的发生率低于距骨骨软骨损伤，且治疗指南尚未确定。本综述的目的是评估手术治疗对OLTPs患者软骨愈合及功能水平（即疼痛减轻、肿胀消退和关节活动范围改善）的有效性。
截至2020年12月，在PubMed/MEDLINE、Cochrane系统评价数据库和谷歌学术进行了全面的文献检索。结局指标为软骨愈合和功能水平。
纳入四项研究OLTPs治疗的研究。三项研究调查了微骨折治疗方法。其中一项研究显示52.0%的患者骨软骨缺损得到填充。所有三项研究均显示功能水平有所改善。一项研究评估了顺行钻孔，两名患者结果相反。一项研究评估了一步法骨髓源性细胞移植，显示68.0%的患者骨软骨缺损得到填充，且患者功能水平有所改善。
通过微骨折和骨髓源性细胞移植（BMDCT）对OLTPs进行关节镜治疗似乎对患者功能水平的结局有效，而BMDCT在缺损填充方面显示出更有前景的结果。然而，这是基于目前现有证据，其方法学质量较差。进一步的研究对于了解这种损伤和评估最佳治疗方法至关重要。
