Sporthopaedicum Regensburg, Regensburg, Germany.
Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Germany.
Cartilage. 2022 Dec;13(4):5-18. doi: 10.1177/19476035221129571. Epub 2022 Oct 15.
The objective of this study was to evaluate the best available mid- to long-term evidence of surgical procedures for the treatment of localized full-thickness cartilage defects of the knee.
Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of Level 1 randomized clinical trials (RCTs), meta-analyses of RCTs and systematic reviews with a minimum follow-up of 5 years. Data extracted included patient demographics, defect characteristics, clinical and radiological outcomes, as well as treatment failures.
Six RCTs and 3 Level 1 systematic reviews were included. Two RCTs compared microfracture (MFx) to periosteum-covered autologous chondrocyte implantation (ACI-P), 1 to matrix-associated ACI (M-ACI) and 2 to osteochondral autograft transplantation (OAT). One study compared OAT to collagen membrane covered ACI (ACI-C). The 3 Level 1 systematic reviews/meta-analyses assessed the outcome of MFx, OAT, and various ACI methods in RCTs. OAT showed significantly better outcomes compared with MFx. In the 2 RCTs comparing ACI-P and MFx, no significant differences in clinical outcomes were seen, whereas significantly better outcomes were reported for M-ACI versus MFx in 1 study including patients with larger defects (5 cm), and for ACI-C versus OAT in terms of Cincinnati Score. Higher failure rates were reported for MFx compared with OAT and for OAT compared with ACI-C, while no significant differences in failure rates were observed for ACI-P compared to MFx.
Restorative cartilage procedures (ACI-C or M-ACI and OAT) are associated with better long-term clinical outcomes including lower complication and failure rates when compared with reparative techniques (MFx). Among the restorative procedures, OAT seems to be inferior to ACI especially in larger defects after longer follow-up periods.
Level I: Systematic review of Level I studies.
本研究旨在评估治疗膝关节局限性全层软骨缺损的手术方法的最佳中-长期现有证据。
使用系统评价和荟萃分析的首选报告项目 (PRISMA) 指南对 1 级随机临床试验 (RCT)、RCT 荟萃分析和至少随访 5 年的系统评价进行系统评价。提取的数据包括患者人口统计学、缺陷特征、临床和影像学结果以及治疗失败情况。
纳入了 6 项 RCT 和 3 项 1 级系统评价。2 项 RCT 比较了微骨折术 (MFx) 与骨膜覆盖的自体软骨细胞移植术 (ACI-P)、1 项与基质相关的 ACI (M-ACI)、2 项与骨软骨自体移植术 (OAT)。1 项研究比较了 OAT 与胶原膜覆盖的 ACI (ACI-C)。3 项 1 级系统评价/荟萃分析评估了 MFx、OAT 和各种 ACI 方法在 RCT 中的结果。OAT 与 MFx 相比，结果明显更好。在 2 项比较 ACI-P 和 MFx 的 RCT 中，临床结果无显著差异，而在 1 项纳入较大缺陷 (5cm) 患者的研究中，M-ACI 与 MFx 相比，报告的结果明显更好，ACI-C 与 OAT 相比，Cincinnati 评分更高。与 OAT 相比，MFx 的失败率更高，与 ACI-C 相比，OAT 的失败率更高，而 ACI-P 与 MFx 相比，失败率无显著差异。
与修复技术 (MFx) 相比，修复性软骨手术 (ACI-C 或 M-ACI 和 OAT) 具有更好的长期临床结果，包括更低的并发症和失败率。在修复性手术中，OAT 似乎不如 ACI，尤其是在更长的随访时间后出现较大的缺陷。
I 级：I 级研究的系统评价。
