Department of Orthopedic Surgery, Joint Preservation Clinic, Caphri School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Orthopedic Surgery, St Elisabeth Ziekenhuis, Tilburg, The Netherlands.
Arch Orthop Trauma Surg. 2023 Aug;143(8):5175-5188. doi: 10.1007/s00402-023-04800-6. Epub 2023 Feb 21.
This study surveyed Dutch orthopedic surgeons on the management of cartilage defects in the knee and the adherence to the recently updated Dutch knee cartilage repair consensus statement (DCS).
A web-based survey was sent to 192 Dutch knee specialists.
The response rate was 60%. Microfracture, debridement and osteochondral autografts are performed by the majority, 93%, 70% and 27% of respondents, respectively. Complex techniques are used by < 7%. Microfracture is mainly considered in defects 1-2 cm (by > 80%) but also in 2-3 cm (by > 40%). Concomitant procedures, e.g., malalignment corrections, are performed by 89%. Twenty-one percent of surgeons treat patients aged 40-60 years. Microfracture, debridement and autologous chondrocyte implantation are not considered to be highly affected by age > 40 years by any of the respondents (0-3%). Moreover, for the middle-aged there is a large spread in treatments considered. In case of loose bodies, the majority (84%) only performs refixation in the presence of attached bone.
Small cartilage defects in ideal patients may be well treated by general orthopedic surgeons. The matter becomes complicated in older patients, or in case of larger defects or malalignment. The current study reveals some knowledge gaps for these more complex patients. Referral to tertiary centers might be indicated, as is stated by the DCS, and this centralization should enhance knee joint preservation. Since the data from present study are subjective, registration of all separate cartilage repair cases should fuel objective analysis of clinical practice and adherence to the DCS in the future.
本研究调查了荷兰骨科医生对膝关节软骨缺损的处理方法以及对最近更新的荷兰膝关节软骨修复共识声明（DCS）的遵循情况。
采用网络调查的方式向 192 名荷兰膝关节专家发送问卷。
应答率为 60%。大多数受访者（93%）采用微骨折术，70%采用清创术，27%采用骨软骨自体移植术。<7%的医生采用复杂技术。微骨折术主要用于 1-2cm 的缺损（>80%），但也用于 2-3cm 的缺损（>40%）。89%的医生会同时进行伴发手术，如对线不良矫正。21%的医生治疗 40-60 岁的患者。没有医生认为微骨折术、清创术和自体软骨细胞移植术会因患者年龄>40 岁而受到高度影响（0-3%）。此外，对于中年患者，他们考虑的治疗方法差异较大。对于游离体，大多数医生（84%）仅在有附着骨的情况下进行重新固定。
对于理想的患者，小的软骨缺损可以由普通骨科医生很好地治疗。在老年患者或更大的缺损或对线不良的情况下，情况会变得复杂。本研究揭示了这些更复杂患者的一些知识空白。正如 DCS 所述，可能需要将这些患者转诊至三级中心，这将加强膝关节的保护。由于本研究中的数据是主观的，因此应该对所有单独的软骨修复病例进行登记，以便将来对临床实践和对 DCS 的遵循情况进行客观分析。
