内侧髌股韧带重建中同期行软骨修复未显示一致的额外临床获益：一项系统综述
简介
该系统性综述纳入18项研究、1632例患者，评估MPFL重建时合并软骨损伤或软骨修复手术的临床效果。结果显示，无论是否处理软骨病变，MPFL重建均能显著改善疼痛与功能，且合并软骨修复组（微骨折、骨软骨移植等）与未修复组在KOOS、Kujala、IKDC评分改善上无显著差异，但并发症率略高。提示对于髌股不稳合并软骨损伤，MPFL重建本身即可带来满意疗效，常规联…
英文摘要
PURPOSE: This review specifically evaluates whether the presence of cartilage lesions, or their surgical treatment, modifies the clinical benefit of medial patellofemoral ligament (MPFL) reconstruction. METHODS: A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Embase, PubMed and Ovid MEDLINE were searched from inception to December 2025. Studies reporting MPFL reconstruction outcomes in adults with reported cartilage lesions and/or concomitant cartilage procedures were included. Comparative studies were analysed as MPFL reconstruction with cartilage restoration versus MPFL reconstruction without cartilage restoration. Cartilage restoration included microfracture, osteochondral grafting, chondrocyte implantation and fixation of osteochondral lesions. Chondroplasty, debridement and no cartilage treatment were classified as nonrestorative. Data were synthesised narratively and with weighted summary statistics. RESULTS: Eighteen studies comprising 1632 patients were included. The mean age was 22.2 years, 32.5% of patients were male, and the mean follow-up was 40.8 months. Cartilage lesions were graded using the International Cartilage Repair Society or Outerbridge classifications. Grade II-IV cartilage lesions were reported in 56.3% of patients, most commonly involving the patella. High-grade (III-IV) lesions were associated with worse baseline scores compared to lower-grade (0-II) lesions. MPFL reconstruction consistently led to significant improvements in pain and function, irrespective of lesion presence or treatment strategy. Weighted summary mean improvements were similar between patients undergoing MPFL reconstruction with cartilage restoration versus no restoration, based on Knee injury and Osteoarthritis Outcome Score (KOOS) Pain (+24.5 [standard deviation, SD = 2.9] vs. +26.2 [2.3]), Kujala (+32.0 [16.6] vs. +30.4 [4.3]) and International Knee Documentation Committee (IKDC) (+25.0 [5.7] vs. +32.7 [1.4]) scores. Chondroplasty and debridement were included in the no restoration category when reported. Reported complication rates were higher with cartilage restoration (5.7%) compared with no restoration (2.8%), although reporting was limited. CONCLUSIONS: Cartilage lesions are common during MPFL reconstruction and may be associated with worse baseline scores. MPFL reconstruction improves pain and function, but current evidence does not demonstrate a consistent additional clinical benefit of concomitant cartilage restoration. Higher-quality comparative studies with longer follow-up are needed. LEVEL OF EVIDENCE: Level IV, systematic review.