Articular cartilage defects in 1,000 knee arthroscopies
Articular cartilage defects in 1,000 knee arthroscopies
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DOI：
10.1053/jars.2002.32839
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发表时间：
2002-09-01
影响因子：
4.7
通讯作者：
Brittberg, M
中科院分区：
文献类型：
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作者：
Hjelle, K;Solheim, E;Brittberg, M
目的：局灶性软骨缺损或骨软骨缺损可能是疼痛和致残的，修复能力差，并可能使患者易患骨关节炎。旨在重建透明软骨的新外科手术已经被引入，结果似乎很有希望。本研究旨在提供需要关节镜检查的症状性膝关节患者的软骨和骨软骨缺损的可靠数据，并计算可能从软骨修复手术中受益的患者的患病率。研究类型：前瞻性研究。方法：1000例连续膝关节镜检查纳入本研究。每次关节镜检查后，外科医生立即填写一份问卷，提供有关结果的详细信息。根据国际腕关节修复学会（ICRS）推荐的系统对软骨和骨软骨病变进行分类。结果：61%的患者发现软骨或骨软骨病变（任何类型）。在19%的患者中发现了局灶性软骨缺损或骨软骨缺损。在这些患者中，61%的患者将其当前膝关节问题与既往创伤相关，分别在42%（n = 81）和26%（n = 50）的患者中发现了伴随的膝关节或前交叉韧带损伤。平均软骨或骨软骨总缺损面积为2.1 cm（2）（范围：0.5 - 12;标准差[SD]：1.5）。主要局灶性软骨或骨软骨缺损位于股骨内侧髁58%，髌骨11%，胫骨外侧11%，股骨外侧髁9%，胫骨托6%，胫骨内侧5%。有人建议，软骨修复手术可能最适合40至50岁以下的患者。年龄小于40岁、45岁或50岁的患者中，单个、明确的ICRS III级或IV级缺损，面积至少为1 cm（2），分别占所有关节镜检查的5.3%、6.1%和7.1%。结论：我们的研究支持关节软骨缺损是常见的论点。它具有前瞻性设计和使用红十字国际委员会建议的新分类系统的优点。这种现代系统侧重于病变范围的客观可测量参数，而不是其表面外观。
Purpose: Focal chondral or osteochondral defects can be painful and disabling, have a poor capacity for repair, and may predispose patients for osteoarthritis. New surgical procedures that aim to reestablish hyaline cartilage have been introduced and the results seem promising. The purpose of this study is to provide reliable data on chondral and osteochondral defects in patients with symptomatic knees requiring arthroscopy and to calculate the prevalence of patients who might benefit from cartilage repair surgery. Type of Study: Prospective study. Methods: One thousand consecutive knee arthroscopies were included in this study. Immediately after each arthroscopy, the surgeon completed a questionnaire providing detailed information about the findings. Chondral and osteochondral lesions were classified in accordance with the system recommended by the International Cartilage Repair Society (ICRS). Results: Chondral or osteochondral lesions (of any type) were found in 61% of the patients. Focal chondral or osteochondral defects were found in 19% of the patients. In these patients, 61% related their current knee problem to a previous trauma, and a concomitant meniscal or anterior cruciate ligament injury was found in 42% (n = 81) and 26% (n = 50), respectively. The mean chondral or osteochondral total defect area was 2.1 cm(2)(range, 0.5 to 12; standard deviation [SD], 1.5). The main focal chondral or osteochondral defect was found on the medial femoral condyle in 58%, patella in 11%, lateral tibia in 11%, lateral femoral condyle in 9%, trochlea in 6%, and medial tibia in 5%. It has been suggested that cartilage repair surgery may be most suitable in patients younger than 40 to 50 years old. A single, well-defined ICRS grade III or IV defect with an area of at least I cm(2) in a patient younger than 40, 45, or 50 years accounted for 5.3%, 6.1%, and 7.1% of all arthroscopies, respectively. Conclusions: Our study supports the contention that articular cartilage defects are common. It has the advantages of a prospective design and use of a new classification system recommended by the ICRS. This modern system focuses on objectively measurable parameters of the lesion's extent and not its surface appearance.