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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Do Focal Chondral Defects of the Knee Increase the Risk for Progression to Osteoarthritis? A Review of the Literature
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Do Focal Chondral Defects of the Knee Increase the Risk for Progression to Osteoarthritis? A Review of the Literature

机译：膝盖的局灶性软骨缺损会增加骨关节炎进展的风险吗？文献综述

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Background: Focal chondral defects (FCDs) of the knee are believed to contribute to the development of osteoarthritis (OA), resulting in pain and dysfunction. Purpose: To investigate whether untreated FCDs of the knee progress to radiographically evident OA over time. Study Design: Systematic review; Level of evidence, 3. Methods: A literature review was performed by searching the PubMed, Embase, and Cochrane Library databases to locate studies evaluating clinical and/or radiological outcomes of patients with FCDs that were diagnosed by arthroscopic surgery or magnetic resonance imaging (MRI) and were left untreated with a minimum 2-year follow-up. Additionally, studies were included if there was a radiographic assessment of OA. Search terms used were “knee,” “focal,” “isolated,” “chondral,” “cartilage,” and “osteoarthritis.” Studies were evaluated based on clinical/radiological outcomes and OA risk factors. The study methodology was assessed using the modified Coleman Methodology Score. Results: Eight studies comprising 1425 knees met the inclusion criteria. All studies were of level 3 evidence. The risk of incident cartilage damage (enlargement of original FCDs or incidence of additional FCDs) at latest follow-up was assessed in 3 studies, while 1 study only reported the incidence of cartilage damage at follow-up. All 4 studies noted an increased progression of cartilage damage at follow-up. The progression of cartilage damage was most commonly seen in the patellofemoral joint and medial femoral condyle but was not associated with the development of knee OA based on the Kellgren-Lawrence grade. MRI of the FCDs revealed increased water content, cartilage deterioration, and proteoglycan loss within the medial and lateral compartments. Conclusion: Patients with untreated FCDs of the knee joint are more likely to experience a progression of cartilage damage, although the studies included in this review did not demonstrate the development of radiographically evident OA within 2 years of follow-up.
机译：背景：人们认为膝盖的局部软骨缺损（FCD）会导致骨关节炎（OA）的发展，从而导致疼痛和功能障碍。目的：研究未经治疗的膝关节FCDs是否随着时间的推移发展成放射学上明显的OA。研究设计：系统评价;证据等级，3。方法：通过检索PubMed，Embase和Cochrane库数据库进行文献综述，以找到评估经关节镜手术或磁共振成像（MRI）诊断的FCD患者的临床和/或放射学结局的研究），并且至少接受2年的随访。此外，如果对OA进行影像学评估，则包括研究。使用的搜索字词是“膝盖”，“焦点”，“隔离”，“软骨”，“软骨”和“骨关节炎”。根据临床/放射学结果和OA危险因素对研究进行评估。使用改良的Coleman方法论评分评估研究方法论。结果：包含1425个膝盖的八项研究符合纳入标准。所有研究均为3级证据。在3项研究中评估了最近一次随访时发生软骨损伤的风险（原始FCD增大或其他FCD发生），而1项研究仅报道了随访时软骨损伤的发生率。所有4项研究均指出，随访时软骨损伤的进展增加。软骨损伤的进展最常见于em股关节和股内侧media，但与基于凯格伦-劳伦斯分级的膝骨关节炎的发展无关。 FCD的MRI显示内侧和外侧隔室内水分含量增加，软骨变质以及蛋白聚糖损失。结论：膝关节FCD未经治疗的患者更有可能经历软骨损伤的进展，尽管该评价中包括的研究未显示随访2年内影像学上明显的OA的发展。

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