Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes
Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes
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DOI：
10.1007/s00167-013-2676-8
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发表时间：
2014-09-01
影响因子：
3.8
通讯作者：
Kumar, Anup
中科院分区：
文献类型：
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作者：
Gobbi, Alberto;Karnatzikos, Georgios;Kumar, Anup
微骨折是针对高需求人群软骨缺损的成熟治疗方法，具有良好的短期效果。本研究的目的是评估微骨折治疗全层软骨缺损运动员的长期临床结果。 1991年至2001年间，我院对170例膝关节全层软骨缺损患者进行微骨折治疗，其中67例纳入本研究并进行前瞻性随访。 61 名运动员 (91%) 接受了最终随访（平均 15.1 年）。平均病变大小为 401 +/- A 27 mm(2)。 Lysholm、Tegner 和国际膝关节文献委员会 (IKDC)（主观-客观）评分在术前、2 年、5 年和最终随访时使用；最后随访时还收集膝关节损伤和骨关节炎结局评分（KOOS）、视觉模拟量表（VAS）和Marx评分。IKDC、Lysholm和Tegner评分在2年时显着增加，但长期逐渐恶化；然而，最终随访时的平均分数明显高于基线。 7 名患者（11%）因前 5 年内再次受伤或持续疼痛而接受另一次手术，被视为失败。截至 2 年底，仅 9 名患者报告在剧烈活动期间出现疼痛和肿胀，而在最终随访时则有 35 名患者报告出现疼痛和肿胀。病变较小的患者（千分之一400 mmA(2)）和年轻患者（千分之30岁）在KOOS、VAS和Marx评分方面表现出明显更好的结果。最终随访时进行的 X 光检查显示，40% 的膝盖骨关节炎进展，其中较大或多处病变的老年患者发生率较高 (p < 0.05)。微骨折应用于病变较小的年轻患者可以在短期和长期随访中提供良好的临床结果；病变大小是比年龄更重要的预后因素。预计治疗后2年和5年临床结果会恶化，长期随访时会出现退行性改变，在患有大而多发病变的老年运动员中发生率更高。
Microfracture is a well-established treatment procedure for chondral defects in high-demand population with good short-term results. The purpose of our study was to evaluate long-term clinical outcome of microfracture treatment in athletes with full-thickness chondral defects.Between 1991 and 2001, 170 patients were treated with microfracture for full-thickness knee chondral lesions at our institute and 67 of them were included in this study and prospectively followed up. Sixty-one athletes (91 %) were available at final follow-up (average 15.1 years). Average lesion size was 401 +/- A 27 mm(2). Lysholm, Tegner and International Knee Documentation Committee (IKDC) (subjective-objective) scores were utilized pre-operatively and at 2-year, 5-year and final follow-up; Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) and Marx scores were also collected at final follow-up.IKDC, Lysholm and Tegner scores increased significantly at 2 years, but gradually deteriorated at long term; however, average scores were significantly above baseline at final follow-up. Seven patients (11 %) were considered as failures as they underwent another operation because of reinjury or persistent pain during the first 5 years. Pain and swelling during strenuous activities was reported only in nine patients by the end of 2 years and in 35 patients at final follow-up. Patients with smaller lesions (a parts per thousand currency sign400 mmA(2)) and younger patients (a parts per thousand currency sign30 years) showed significantly better results in KOOS, VAS and Marx scores. Radiographs performed at final follow-up showed evidence of progression of osteoarthritis changes in 40 % of the knees, with higher rate in older patients with large or multiple lesions (p < 0.05).Microfracture when applied in young patients with smaller lesions can offer good clinical results at short- and long-term follow-up; lesion size is more important prognostic factor of outcome than age. Deterioration of the clinical outcome should be expected after 2 and 5 years post-treatment, and degenerative changes are present at long-term follow-up, with higher rate in older athletes with large, multiple lesions.IV.