述评：软骨修复即关节保留，而关节保留需治疗整个关节
简介
这篇编辑评论指出，膝关节局灶性软骨损伤很少孤立存在，常合并力线异常、半月板缺损、韧带不稳及髌股轨迹不良。作者强调近十年软骨手术最重要的理念转变，是将截骨、半月板移植、韧带重建等伴随手术从“附加操作”重新定位为保护移植物、纠正原始病因的干预措施，现有证据支持一期联合实施以改善移植物存活率。临床含义在于，软骨修复应视为整体关节保存策略，需基于全长X线片等全面评估…
英文摘要
Focal articular cartilage lesions of the knee rarely occur in isolation. Malalignment, meniscal deficiency, ligamentous instability, and patellofemoral maltracking frequently coexist, creating the mechanical environment in which cartilage restoration either succeeds or fails. In our view, the most important conceptual shift in cartilage surgery over the past decade has been the reframing of concomitant procedures (osteotomy, meniscal allograft transplantation, ligament reconstruction, and tibial tubercle osteotomy) from add-ons into graft-protecting interventions that address the drivers of the original lesion. Available evidence increasingly supports performing these procedures concomitantly at the index operation without compromising outcomes, and in the setting of malalignment or meniscal deficiency, it suggests improved survivorship. The literature remains heterogeneous and cannot yet define precise correction thresholds, ideal alignment targets, or a uniform definition of failure. Still, the governing principle is clear: cartilage restoration is joint preservation, and joint preservation requires treating the whole joint. Ultimately, progress in cartilage restoration will require more than better grafts, scaffolds, cells, or biologic augmentation. It will require a more precise understanding of the mechanical environment into which these restorative procedures are placed, supported by long-leg alignment imaging, meniscal and patellofemoral assessment, advanced imaging, gait analysis, and patient-specific risk modeling. Combined intervention strategies will optimize the knee organ environment and enhance the likelihood for disease modification over time with sustainable and meaningful outcomes.