Tian Guangzhao, Li Runmeng, Yang Yongkang, Ning Chao, Guo Quanyi
Institute of Orthopedics, First Medical Center, General Hospital of Chinese PLA, Beijing, 100853, P. R. China.
School of Medicine, Nankai University, Tianjin, 300071, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Jul 15;38(7):889-895. doi: 10.7507/1002-1892.202402056.
To summarize the classic and latest treatment techniques for localized knee cartilage lesions in clinical practice and create a new comprehensive clinical decision-making process.
The advantages and limitations of various treatment methods for localized knee cartilage lesions were summarized by extensive review of relevant literature at home and abroad in recent years.
Currently, there are various surgical methods for treating localized knee cartilage injuries in clinical practice, each with its own pros and cons. For patients with cartilage injuries less than 2 cm and 2-4 cm with bone loss are recommended to undergo osteochondral autograft (OAT) and osteochondral allograft (OCA) surgeries. For patients with cartilage injuries less than 2 cm and 2-4 cm without bone loss had treatment options including bone marrow-based techniques (micro-fracture and ogous matrix induced chondrogenesis), autologous chondrocyte implantation (ACI)/matrix-induced ACI, particulated juvenile allograft cartilage (PJAC), OAT, and OCA. For patients with cartilage injuries larger than 4 cm with bone loss were recommended to undergo OCA. For patients with cartilage injuries larger than 4 cm without bone loss, treatment options included ACI/matrix-induced ACI, OAT, and PJAC.
There are many treatment techniques available for localized knee cartilage lesions. Treatment strategy selection should be based on the size and location of the lesion, the extent of involvement of the subchondral bone, and the level of evidence supporting each technique in the literature.
总结临床实践中局部膝关节软骨损伤的经典及最新治疗技术,并创建一个新的综合临床决策流程。
通过广泛回顾近年来国内外相关文献,总结局部膝关节软骨损伤各种治疗方法的优缺点。
目前,临床实践中治疗局部膝关节软骨损伤有多种手术方法,每种方法都有其优缺点。对于软骨损伤小于2厘米且伴有2-4厘米骨质缺损的患者,建议进行自体骨软骨移植(OAT)和异体骨软骨移植(OCA)手术。对于软骨损伤小于2厘米且无骨质缺损的2-4厘米患者,治疗选择包括基于骨髓的技术(微骨折和骨膜诱导软骨生成)、自体软骨细胞植入(ACI)/基质诱导ACI、颗粒状青少年异体软骨(PJAC)、OAT和OCA。对于软骨损伤大于4厘米且伴有骨质缺损的患者,建议进行OCA。对于软骨损伤大于4厘米且无骨质缺损的患者,治疗选择包括ACI/基质诱导ACI、OAT和PJAC。
局部膝关节软骨损伤有多种治疗技术。治疗策略的选择应基于损伤的大小和位置、软骨下骨的累及程度以及文献中支持每种技术的证据水平。