自体软骨碎片植入治疗膝关节局灶性软骨缺损的短期至中期临床结果与微骨折及自体软骨细胞植入相当：一项系统综述
简介
该系统综述纳入41项研究、2116例膝关节局灶软骨缺损患者，比较自体软骨微粒植入（AMCI）与微骨折术和ACI/MACI。结果显示各组IKDC、KOOS、Lysholm、Tegner及VAS疼痛无显著差异，AMCI失败率最低（0%），再手术率也倾向更低。AMCI短期至中期疗效至少不劣于微骨折术和ACI/MACI，可作替代选择，但现有研究异质、长期数据有限。
英文摘要
PURPOSE: To evaluate the safety and efficacy of autologous minced cartilage implantation (AMCI) compared with microfracture (MFX) and autologous chondrocyte implantation (ACI)/matrix-assisted ACI (MACI). METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Embase, and Cochrane databases were queried in May 2025. Inclusion criteria were Level I to IV human studies published between 2015 and 2025 with ≥12-month follow-up and reporting ≥2 validated clinical outcomes. Analysis of patient cohorts was performed using forest plots to make qualitative assessments, whereas descriptive statistics and ranges were used to report quantitative data to avoid heterogeneous pooling. RESULTS: A total of 41 studies (2116 patients) were included. Of these, 1590 underwent ACI/MACI, 302 MFX, and 224 AMCI. The mean patient age was 34.4 years for ACI/MACI, 45.0 years for MFX, and 32.7 years for AMCI. The mean follow-up was 61.1 months for ACI/MACI, 58.6 months for MFX, and 29.3 months for AMCI. Overall, there were no significant differences between International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score subscores, Lysholm, Tegner, and Visual Analog Scale pain at postoperative follow-up after ACI, MACI, MFX, and AMCI. Most relevantly, there was no significant difference between International Knee Documentation Committee for ACI (50.91-92.70), MACI (34.18-89.57), MFX (37.63-79.53), and AMCI (56.97-87.29). Qualitative analysis suggests that failure was lowest in AMCI (0%) compared with MFX (1.32%) and ACI/MACI (3.21%), and reoperation rates were variably reported but tended to be lower in AMCI and MFX (n = 10 and n = 14, respectively) compared with ACI/MACI (n = 155). CONCLUSIONS: AMCI shows clinical outcomes that are at least comparable to ACI, MACI, and MFX and may be an appropriate alternative treatment for focal chondral defects of the knee. However, available studies are heterogeneous, and long-term data for AMCI remain limited. LEVEL OF EVIDENCE: Level IV, systematic review of Level I to IV studies.