Lin Chien-Chung, Kuo Tai-Chih, Shen Jian-Hong
Department of Orthopedic Surgery, Taipei City Hospital, Taipei, Taiwan.
University of Taipei, Taipei, Taiwan.
Medicine (Baltimore). 2025 Aug 8;104(32):e43865. doi: 10.1097/MD.0000000000043865.
This study aimed to structure and evaluate the effectiveness of the Arthroscopic Cartilage Regeneration Facilitating Procedure (ACRFP) in treating medial osteoarthritis of the knee, focusing on its impact on patient outcomes, specifically changes in numerical rating scale pain scores and patient satisfaction. This article addresses the lack of detailed procedural steps in the current literature on ACRFP surgery. A retrospective review was conducted of 108 patients (143 knees) who underwent ACRFP. The inclusion criteria were patients over 40 years of age who experienced anterior knee pain or crepitus, a palpable band at the medial femoral condyle, a diagnosis of medial osteoarthritis of the knee via radiography (Kellgren and Lawrence grades 2-4), and had undergone conservative treatment for >6 months. Patients who had undergone prior knee surgery or were under 40 years of age were excluded. Surgical techniques including diagnostic arthroscopy, medial synovectomy, medial release, lateral release, and any additional necessary orthopedic procedures have been meticulously documented to improve procedural clarity and reproducibility. The outcomes were assessed based on subjective satisfaction (categorized as excellent, good, fair, or poor) and numerical rating scale pain scores. Following exclusions and losses to follow-up, 88 patients (58 female and 30 male), involving a total of 120 knees, completed at least 3 years of follow-up. The median age was 69.8 years. The procedure demonstrated a significant reduction in pain scores (from a mean of 6.5 preoperatively to 1.2 postoperatively; P < .001). Satisfactory outcomes were reported in 87.5% of the cases, with patients with X-ray grade 2 showing higher rates of excellent satisfaction. Our outcomes are consistent with those reported by developers of this surgical technique. The detailed surgical technique, divided into 5 main parts and further delineated into ten key steps, facilitated the achievement of these outcomes. This study provides a standard operating procedure for ACRFP that enhances the reproducibility of the technique and offers a reliable alternative to total knee arthroplasty in patients with medial osteoarthritis of the knee. We hypothesize that a structured ACRFP could open new treatment avenues for degenerative knee osteoarthritis, inviting further validation from the orthopedic community.
本研究旨在构建并评估关节镜下软骨再生促进手术（ACRFP）治疗膝关节内侧骨关节炎的有效性，重点关注其对患者预后的影响，特别是数字评分量表疼痛评分的变化和患者满意度。本文弥补了当前ACRFP手术文献中缺乏详细手术步骤的不足。对108例（143膝）接受ACRFP手术的患者进行了回顾性研究。纳入标准为年龄超过40岁、有膝关节前部疼痛或摩擦音、股骨内侧髁可触及条索、经X线检查诊断为膝关节内侧骨关节炎（Kellgren和Lawrence分级2 - 4级）且接受保守治疗超过6个月的患者。曾接受过膝关节手术或年龄在40岁以下的患者被排除。包括诊断性关节镜检查、内侧滑膜切除术、内侧松解术、外侧松解术以及任何其他必要的骨科手术在内的手术技术均已详细记录，以提高手术的清晰度和可重复性。根据主观满意度（分为优、良、中、差）和数字评分量表疼痛评分评估结果。经过排除和失访后，88例患者（58例女性和30例男性），共120膝，完成了至少3年的随访。中位年龄为69.8岁。该手术显示疼痛评分显著降低（术前平均为6.5，术后为1.2；P < 0.001）。87.5%的病例报告了满意的结果，X线2级患者的优秀满意度更高。我们的结果与该手术技术开发者报告的结果一致。详细的手术技术分为5个主要部分，并进一步细分为10个关键步骤，有助于实现这些结果。本研究为ACRFP提供了一种标准操作规程，提高了该技术的可重复性，并为膝关节内侧骨关节炎患者提供了一种可靠的全膝关节置换替代方案。我们假设结构化的ACRFP可为退行性膝关节骨关节炎开辟新的治疗途径，有待骨科界进一步验证。
