ICRS-FIFA-Aspetar 关于足球运动员膝关节软骨损伤治疗的共识：第二部分——基于RAND/UCLA适当性方法的不同临床场景下针对关节软骨病变的特定手术方案适宜性
简介
本研究由ICRS、FIFA与Aspetar联合发起，采用RAND/UCLA适当性方法，针对竞技足球运动员症状性膝关节软骨损伤，评估六种手术方案（清创、清创+生物制剂、骨髓刺激术、自体骨软骨移植、同种异体骨软骨移植、再生技术）在不同临床场景下的适用性。17位专家基于病灶位置、缺损大小、骨受累情况及患者偏好（快速重返运动 vs. 长期疗效）四大因素，共评估96个…
英文摘要
Knee articular cartilage lesions are frequent in football players, but evidence for the most suitable surgical treatments is lacking. The aim of this International Cartilage Regeneration & Joint Preservation Society, Fédération Internationale de Football Association and Aspetar (ICRS-FIFA-Aspetar) consensus was to develop expert-based, patient-specific practical recommendations on the appropriateness of surgical treatments for symptomatic knee articular cartilage lesions in competitive football players. The RAND/UCLA Appropriateness Method was used by 17 voting experts to provide recommendations on the suitability of six different surgical procedures (debridement, debridement+orthobiologics, bone marrow stimulation procedures, osteochondral autograft transplantation, allografts, and regenerative procedures) depending on four key clinical considerations: lesion location, defect size, bone involvement, and patient preference towards higher priority for a quick return to play or long-term results. These resulted in 96 scenarios (16 clinical scenarios for six surgical procedures). Altogether, in 94% of clinical scenarios, at least one surgical procedure was considered appropriate. Patient preference had the highest influence on the results. Debridement plus orthobiologics was most often considered appropriate in patients preferring a quick return to play, while regenerative techniques were more often considered appropriate with patients prioritising long-term results. Osteochondral autograft transplantation and allografts were considered appropriate only in selected scenarios, whereas bone marrow stimulation procedures were considered inappropriate or uncertain. The recommendations established by this ICRS-FIFA-Aspetar consensus on the appropriateness of different surgical procedures to treat symptomatic articular cartilage lesions in competitive football players should be used as broad guidelines, but the preferred treatment should be player-specific.