膝关节急性创伤性软骨损伤的处理：叙述性综述
简介
这篇叙述性综述总结膝关节急性创伤性软骨损伤的诊断措施及非手术和手术治疗选择，并重点讨论细胞治疗和重返运动（RTP）指标。作者指出，现有证据异质，国际共识和指南尚不能据此给出强推荐；治疗不成功者可见向创伤后骨关节炎（PTOA）早期退变进展，因此处理时需仔细选择患者，并通过临床检查和影像学充分评估、表征病灶，尤其对希望早期有效重返运动的年轻有症状运动员。不同治疗…
英文摘要
BACKGROUND AND OBJECTIVE: Traumatic cartilage injuries are common in the general population, affecting up to 50% of athletes, as well as a higher portion of the general population, many of whom remains asymptomatic. Although a large volume of literature focuses on the natural history, diagnosis and management of widespread degenerative cartilage disease in the form of osteoarthritis (OA), there is less evidence available for the management of acute cartilage injuries following trauma. Following a previous review by Brittberg in 2018 as well as the recently published consensus statements on the topic of cartilage injuries, the aim of this study was to perform a review on the topic of acute traumatic cartilage injuries, in hope of providing a contemporary description of their diagnosis and management with respect to recent literature. METHODS: Following invitation, a thorough review of current literature was performed by two authors with the aim of analyzing contempory diagnostic and therapeutic aspects of traumatic cartilage management in the knee. KEY CONTENT AND FINDINGS: A summary of measures to be considered in the diagnosis of acute traumatized cartilage is provided, alongside the comtemporary non-operative and operative options are discussed. Specific focus on cell-based therapies and return to play (RTP) metrics are discussed in the text. CONCLUSIONS: It is clear that in the last number of decades that our knowledge of the natural history surrounding acute traumatic cartilage injuries, their diagnosis and optimal management has been ever growing. However, these injuries are still troublesome for the young symptomatic patient, particularly those athletes hoping for early and effective RTP. Careful patient selection with thorough lesion assessment and characterization through clinical exam and radiological evaluation is warranted when managing traumatic cartilage lesions, particularly as unsuccessfully treatment has been shown to demonstrate a clear progression to early degenerative change in the form of post-traumatic osteoarthritis (PTOA). Treatment options vary in morbidity, effectiveness and regulatory approval, yielding international consensus statements and guidelines that cannot yet offer strong recommendations based on heterogenous evidence. Ultimately, consistency in licensing and technique will permit reliable randomised controlled trials and meta-analyses, upon which definitive international clinical guidance can be based.