Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
J Bone Joint Surg Am. 2024 Nov 6;106(21):1991-2000. doi: 10.2106/JBJS.23.00568. Epub 2024 Sep 16.
Focal cartilage lesions (FCLs) are frequently found during knee arthroscopies and may impair quality of life (QoL) significantly. Several treatment options with good short-term results are available, but the natural history without any treatment is largely unknown. The aim of this study was to evaluate patient-reported outcome measures (PROMs), the need for subsequent cartilage surgery, and the risk of treatment failure 20 years after diagnosis of an FCL in the knee.
Patients undergoing any knee arthroscopy for an FCL between 1999 and 2012 in 6 major Norwegian hospitals were identified. Inclusion criteria were an arthroscopically classified FCL in the knee, patient age of ≥18 years at surgery, and any preoperative PROM. Exclusion criteria were lesions representing knee osteoarthritis or "kissing lesions" at surgery. Demographic data, later knee surgery, and PROMs were collected by questionnaire. Regression models were used to adjust for and evaluate the factors impacting the long-term PROMs and risk factors for treatment failure (defined as knee arthroplasty, osteotomy, or a Knee injury and Osteoarthritis Outcome Score-Quality of Life [KOOS QoL] subscore of <50).
Of the 553 eligible patients, 322 evaluated patients (328 knees) were included and analyzed. The mean follow-up was 19.1 years, and the mean age at index FCL surgery was 36.8 years (95% confidence interval [CI], 35.6 to 38.0 years). The patients without knee arthroplasty or osteotomy had significantly better mean PROMs (pain, Lysholm, and KOOS) at the time of final follow-up than preoperatively. At the time of follow-up, 17.7% of the knees had undergone subsequent cartilage surgery. Nearly 50% of the patients had treatment failure, and the main risk factors were a body mass index of ≥25 kg/m 2 (odds ratio [OR] for overweight patients, 2.0 [95% CI, 1.1 to 3.6]), >1 FCL (OR, 1.9 [CI, 1.1 to 3.3]), a full-thickness lesion (OR, 2.5 [95% CI, 1.3 to 5.0]), and a lower level of education (OR, 1.8 [95% Cl, 1.1 to 2.8]). Autologous chondrocyte implantation (ACI) was associated with significantly higher KOOS QoL, by 17.5 (95% CI, 3.2 to 31.7) points, and a lower risk of treatment failure compared with no cartilage treatment, microfracture, or mosaicplasty.
After a mean follow-up of 19 years, patients with an FCL who did not require a subsequent knee arthroplasty had significantly higher PROM scores than preoperatively. Nonsurgical treatment of FCLs had results equal to those of the surgical FCL treatments except for ACI, which was associated with a better KOOS and lower risk of treatment failure. Full-thickness lesions, >1 FCL, a lower level of education, and a greater BMI were the main risk factors associated with poorer results.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
膝关节镜检查中经常发现局灶性软骨病变（FCL），这可能会显著影响生活质量（QoL）。有几种短期效果较好的治疗方法，但未经任何治疗的自然病史在很大程度上尚不清楚。本研究旨在评估膝关节 FCL 患者的患者报告结局指标（PROMs）、后续软骨手术的需求以及 20 年后 FCL 诊断的治疗失败风险。
在 6 家挪威主要医院对 1999 年至 2012 年期间因 FCL 行任何膝关节镜检查的患者进行了识别。纳入标准为膝关节镜分类的 FCL、手术时患者年龄≥18 岁以及任何术前 PROM。排除标准为在手术中代表膝关节骨关节炎或“亲吻病变”的病变。通过问卷调查收集人口统计学数据、后续膝关节手术和 PROMs。回归模型用于调整和评估长期 PROMs 的影响因素以及治疗失败的风险因素（定义为膝关节置换术、截骨术或膝关节损伤和骨关节炎结局评分-生活质量[KOOS QoL]子评分<50）。
在 553 名符合条件的患者中，有 322 名接受评估的患者（328 个膝关节）入选并进行了分析。平均随访时间为 19.1 年，FCL 手术时的平均年龄为 36.8 岁（95%置信区间[CI]，35.6 至 38.0 岁）。在最终随访时，未行膝关节置换术或截骨术的患者的 PROMs（疼痛、Lysholm 和 KOOS）平均明显优于术前。在随访时，有 17.7%的膝关节接受了后续软骨手术。近 50%的患者治疗失败，主要风险因素为体重指数（BMI）≥25kg/m 2（超重患者的优势比[OR]，2.0[95%CI，1.1 至 3.6]）、>1 个 FCL（OR，1.9[CI，1.1 至 3.3]）、全层病变（OR，2.5[CI，1.3 至 5.0]）和较低的教育水平（OR，1.8[CI，1.1 至 2.8]）。与非软骨治疗、微骨折或马赛克plasty 相比，自体软骨细胞移植（ACI）与 KOOS QoL 显著提高了 17.5（95%CI，3.2 至 31.7）分，并且治疗失败的风险较低。
在平均随访 19 年后，未行后续膝关节置换术的 FCL 患者的 PROM 评分明显高于术前。除 ACI 外，FCL 的非手术治疗结果与手术 FCL 治疗结果相当，ACI 与更好的 KOOS 和较低的治疗失败风险相关。全层病变、>1 个 FCL、较低的教育水平和较高的 BMI 是与较差结果相关的主要风险因素。
治疗性 III 级。有关完整的证据水平描述，请参见作者说明。
