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Thứ Bảy, 18/11/17 17:18:52 (GMT+7)
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Điều trị tổn thương sụn khớp gối ở vận động viên

Một nghiên cứu đáng tin cậy phân tích 11 nghiên cứu về kết quả điều trị phẫu thuật tổn thương sụn khớp gối ở vận động viên bằng 3 phương pháp thường dùng: microfracture, ghép tế bào sụn đồng loại(ACI) và chuyển ghép sụn xương(OATS). Kết quả cho thấy phương pháp microfracture kém hiệu quả nhất so với hai phương pháp còn lại, đặc biệt ở những tổn thương >2cm2.  

 

Treatment of Chondral Defects in the Athlete's Knee

Joshua D. Harris, M.D.a, Robert H. Brophy, M.D.c, Robert A. Siston, Ph.D.b, David C. Flanigan, M.D.

Received 8 December 2009; accepted 28 December 2009.

Purpose

To determine which surgical technique(s) has improved outcomes and enables athletes to return to their preinjury level of sports and which patient and defect factors significantly affect outcomes after cartilage repair or restoration.

Methods

We conducted a search of multiple medical databases, evaluating studies of articular cartilage repair in athletes.

Results

We identified 11 studies for inclusion (658 subjects). Only 1 randomized clinical trial was identified. All other studies were prospective cohorts, case-control studies, or case series reporting results after either microfracture or autologous chondrocyte implantation (ACI) or osteoarticular transplantation (OATS). Eight different clinical outcomes measures were used. Better clinical outcomes were observed after ACI and OATS versus microfracture. Results after microfracture tended to deteriorate with time. The overall rate of return to preinjury level of sports was 66%. The timing of return to the preinjury level of sports was fastest after OATS and slowest after ACI. Defect size of less than 2 cm2, preoperative duration of symptoms of less than 18 months, no prior surgical treatment, younger patient age, and higher preinjury and postsurgical level of sports all correlated with improved outcomes after cartilage repair, especially ACI. Results after microfracture were worse with larger defects. The rate of return to sports was generally lower after microfracture versus ACI or OATS, and if a patient was able to return to sports, performance was diminished as well.

Conclusions

Management of chondral defects in the athlete is complex and multifactorial. There is little high-level evidence to support one procedure over another, although good short-term and midterm outcomes with a fair rate of return to preinjury level of sports can be achieved with cartilage repair and restoration in the athlete.

Level of Evidence

Level IV, systematic review.

a Department of Orthopaedics, Division of Sports Medicine Cartilage Repair Center, The Ohio State University Medical Center, Columbus, Ohio

b Department of Mechanical Engineering, The Ohio State University, Columbus, Ohio

c Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A.

(Tạp chí Nội soi khớp 05/2010)

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