关节镜下单锚钉固定与微骨折术治疗青少年及年轻成人膝关节负重区骨软骨骨折的长期疗效比较
简介
该回顾性研究纳入24例青少年及年轻成人的股骨髁或滑车负重区骨软骨骨折患者，对比关节镜下单锚钉原位固定与微骨折术的长期疗效，平均随访93.7个月。结果显示单锚钉组术中软骨接触面积比更高，末次随访时Lysholm、IKDC、Tegner评分及MRI MOCART 2.0评分均显著优于微骨折组，且无固定失败或翻修。对于可复位骨软骨块的年轻患者，单锚钉固定通过保留自…
英文摘要
PURPOSE: Osteochondral fractures involving the weight-bearing area of the knee in young patients require stable restoration of the native osteochondral fragment whenever possible. This study aimed to evaluate the long-term clinical and radiological outcomes of arthroscopic single-anchor fixation and to compare them with those of microfracture. METHODS: This retrospective comparative study included 24 adolescents and young adults with osteochondral fractures of the femoral condyle or trochlear region treated between 2016 and 2017. Twelve patients underwent arthroscopic single-anchor in situ fixation, and 12 underwent microfracture. The fixation technique used one double-loaded suture anchor to obtain multi-point compression of the osteochondral fragment while preserving the subchondral plate. Clinical outcomes were assessed using the Lysholm, International Knee Documentation Committee, and Tegner scores. Magnetic resonance imaging was evaluated using the MOCART 2.0 score. The mean follow-up was 93.7 months. RESULTS: The single-anchor group showed a significantly higher intraoperative contact area ratio than the microfracture group (96.5% ± 3.2% vs. 85.8% ± 5.6%, P < 0.001). At final follow-up, the single-anchor group had superior Lysholm scores (91 ± 5 vs. 83 ± 8, P = 0.009), IKDC scores (86 ± 6 vs. 78 ± 7, P = 0.010), and Tegner activity levels (5.0 ± 1.1 vs. 3.9 ± 0.9, P = 0.012). MRI evaluation also favored single-anchor fixation, with higher MOCART 2.0 scores at 12 months (82.3 ± 6.4 vs. 61.7 ± 8.1, P < 0.001) and at final follow-up (79.4 ± 7.0 vs. 57.9 ± 9.0, P < 0.001). No fixation failure or revision occurred in the single-anchor group, whereas two patients in the microfracture group required reoperation. CONCLUSION: Arthroscopic single-anchor in situ fixation provided durable clinical improvement and superior long-term MRI repair quality compared with microfracture in adolescents and young adults with osteochondral fractures of the knee weight-bearing area. By preserving the native osteochondral fragment and minimizing subchondral disruption, this technique may represent a useful joint-preserving option for selected young patients with reducible osteochondral fragments.