Triana Jairo, Li Zachary I, Rao Naina, Kingery Matthew T, Strauss Eric J
Department of Orthopedic Surgery, New York University Langone Health, 301 East 17th Street, New York, NY, 10016, USA.
Curr Rev Musculoskelet Med. 2023 Dec;16(12):575-586. doi: 10.1007/s12178-023-09872-w. Epub 2023 Oct 7.
Numerous cartilage restoration techniques have proven to be effective in the treatment of articular cartilage defects. The ultimate goal of these procedures is to improve pain and function, thereby increasing the likelihood of a patient's return to physical activity. Postoperative rehabilitation is a key component for a successful and expedient return to activities. The purpose of this article is to review the current literature regarding common surgical options, rehabilitation protocols, and performance outcomes after operative treatment of articular cartilage defects.
Studies have demonstrated improved short- to long-term outcomes in a majority of techniques. However, the clinical benefits of microfracture are short-lived, which has led to the use of alternative procedures. Rehabilitation protocols are not standardized, but emphasis has been placed on bracing, weightbearing, early continuous passive range of motion, and strengthening to improve function. There is growing evidence to suggest that accelerated rehabilitation after matrix-induced autologous chondrocyte implantation may result in superior outcomes compared to delayed rehabilitation. Overall, most techniques result in satisfactory rates of return to play, though existing comparative studies typically include patients with heterogeneous pathology, complicating effective synthesis of outcomes data. In appropriately selected patients, cartilage restoration procedures after articular cartilage injury result in favorable patient-reported clinical outcomes and high rates of return to play. While studies emphasize the critical role that rehabilitation plays with respect to outcomes after surgery, there are substantial inconsistencies in protocols across techniques.
众多软骨修复技术已被证明在治疗关节软骨缺损方面有效。这些手术的最终目标是减轻疼痛、改善功能，从而增加患者恢复体力活动的可能性。术后康复是成功且迅速恢复活动的关键组成部分。本文旨在综述有关关节软骨缺损手术治疗后的常见手术选择、康复方案及功能结果的当前文献。
研究表明，大多数技术的短期至长期效果均有所改善。然而，微骨折的临床益处是短暂的，这促使了其他手术的应用。康复方案尚未标准化，但重点在于支具固定、负重、早期持续被动活动范围以及增强力量以改善功能。越来越多的证据表明，与延迟康复相比，基质诱导自体软骨细胞植入术后加速康复可能会带来更好的效果。总体而言，大多数技术的重返运动率令人满意，不过现有的比较研究通常纳入了病理情况各异的患者，使得结果数据的有效综合变得复杂。在适当选择的患者中，关节软骨损伤后的软骨修复手术可带来良好的患者报告临床结果和较高的重返运动率。虽然研究强调了康复对术后结果的关键作用，但各技术的康复方案存在很大差异。
