Valisena Silvia, Azogui Benjamin, Nizard Rémy S, Tscholl Philippe M, Cavaignac Etienne, Bouché Pierre-Alban, Hannouche Didier
Department of Orthopaedics, University Hospitals of Geneva, Genève, Switzerland.
Department of Orthopaedics, Hôpital Lariboisière, Paris, France.
EFORT Open Rev. 2024 Aug 1;9(8):785-795. doi: 10.1530/EOR-23-0089.
Despite the publication of several randomized controlled trials (RCTs), it is not clear which technique for the treatment of focal chondral and osteochondral defects of the knee grants the best clinical outcome. The aim of this network meta-analysis (NMA) was to compare the efficacy and safety of microfractures (MF), autologous chondrocyte implantation (ACI), autologous matrix-induced chondrogenesis (AMIC), osteochondral autograft transplantation (OCT) at short (< 1 year), intermediate (1-5 years) and long-term (> 5 years).
We carried out an NMA with Bayesian random-effect model, according to PRISMA guidelines. The search was performed in MEDLINE, EMBASE, Web of Science, CENTRAL, CINAHL, SPORTDiscus, clinicaltrials.gov, WHO ICTRP, from inception to November 2022. The eligibilities were randomized controlled trials on patients with knee chondral and osteochondral defects, undergoing microfractures, OCT, AMIC, ACI, without restrictions for prior or concomitant surgery on ligaments, menisci or limb alignment, prior surgery for fixation or ablation of osteochondritis dissecans fragments, and prior cartilage procedures as microfractures, drilling, abrasion, or debridement.
Nineteen RCTs were included. No difference among treatments was shown in the pooled comparison of patient reported outcome measures (PROMs) at any timepoint. Safety data were not available for all trials due to the heterogeneity of reporting, but chondrospheres seemed to have lower failure and reoperation rates.
This NMA showed no difference for PROMs with any technique. The lower failure and reoperation rates with chondrospheres must be interpreted with caution since adverse event data was heterogenous among trials. The standardization of the efficacy and safety outcome measures for future trials on knee cartilage repair and regeneration is necessary.
尽管已发表了多项随机对照试验（RCT），但尚不清楚哪种治疗膝关节局灶性软骨和骨软骨缺损的技术能带来最佳临床结果。本网状Meta分析（NMA）的目的是比较微骨折（MF）、自体软骨细胞植入（ACI）、自体基质诱导软骨形成（AMIC）、骨软骨自体移植（OCT）在短期（<1年）、中期（1 - 5年）和长期（>5年）的疗效和安全性。
我们根据PRISMA指南，采用贝叶斯随机效应模型进行了NMA。检索了MEDLINE、EMBASE、科学网、CENTRAL、CINAHL、SPORTDiscus、clinicaltrials.gov、世界卫生组织国际临床试验注册平台，检索时间从建库至2022年11月。纳入标准为关于膝关节软骨和骨软骨缺损患者的随机对照试验，这些患者接受微骨折、OCT、AMIC、ACI治疗，对韧带、半月板或肢体对线的既往或同期手术、骨软骨炎剥脱性骨软骨炎碎片的固定或切除既往手术以及既往软骨手术如微骨折、钻孔、磨削或清创术无限制。
纳入了19项RCT。在任何时间点的患者报告结局指标（PROMs）汇总比较中，各治疗组之间均未显示出差异。由于报告的异质性，并非所有试验都有安全数据，但软骨球似乎具有较低的失败率和再次手术率。
本NMA显示任何技术的PROMs均无差异。由于各试验之间不良事件数据存在异质性，因此对软骨球较低的失败率和再次手术率必须谨慎解读。未来膝关节软骨修复和再生试验的疗效和安全性结局指标标准化是必要的。
