前交叉韧带重建术中同期处理孤立性软骨损伤可提高病灶稳定性但2年临床疗效相似：一项基于登记系统的配对二次关节镜研究
简介
基于瑞典膝关节韧带登记处156例配对患者的数据，该研究比较了前交叉韧带重建术中同期处理（清创或微骨折）与不处理孤立软骨病变的2年结果。二次关节镜探查发现，手术处理组病变稳定性更高（21.8% vs. 5.1%），尤其在ICRS I-II级低级别病变中效果显著，但两组2年无翻修生存率及患者报告结局（KOOS、EQ-5D）无差异。提示术中处理软骨病变虽能改善结构…
英文摘要
PURPOSE: The management of cartilage lesions encountered during anterior cruciate ligament reconstruction (ACLR) remains debated, with limited evidence on whether surgical treatment affects lesion progression or outcomes. This study aimed to compare structural progression and clinical outcomes of isolated cartilage lesions treated or left untreated during primary ACLR, using data from the Swedish Knee Ligament Registry (SKLR). METHODS: Patients who underwent both primary and revision ACLR between 2005 and 2024 were identified in the SKLR. Inclusion required an isolated cartilage lesion documented arthroscopically at primary ACLR. Multi-compartment lesions and multi-ligament procedures were excluded. A 1:1 matched analysis compared patients who underwent surgical cartilage treatment (debridement or microfracture) with untreated patients. Structural evolution was assessed by comparing arthroscopic findings at primary and revision ACLR and classified as stable, progressed or regressed based on International Cartilage Repair Society (ICRS) grade and lesion size. Secondary analyses included 2-year revision-free survival and patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score, EuroQol 5-Dimension questionnaire, EuroQol Visual Analogue Scale) in patients without revision within 2 years. RESULTS: A matched cohort of 156 patients (78 treated and 78 untreated) was included. Baseline characteristics were comparable, except for operated side (p = 0.007). At revision ACLR, treated patients showed higher lesion stability than untreated patients (21.8% vs. 5.1%; p = 0.005). This effect was significant in low-grade lesions (ICRS I-II), with higher stability (27.1% vs. 5.1%; p = 0.002) and lower progression (15.3% vs. 32.2%; p = 0.050), while no differences were observed in high-grade lesions. Two-year revision-free survival was comparable (log-rank p = 0.53). Among patients without revision (n = 88), both groups improved in patient-reported outcome measures with no between-group differences. CONCLUSIONS: Surgical treatment of isolated cartilage lesions during primary ACLR was associated with greater structural stability at revision surgery, particularly in low-grade lesions, without superior short-term clinical outcomes. These findings suggest structural benefits may not translate into early improvement. LEVEL OF EVIDENCE: Level II, prospective comparative study.