当代膝关节软骨缺损管理（第一部分）：治疗选择框架
简介
膝关节局灶性软骨缺损的临床异质性高，尚无通用解决方案。本综述提出一个基于约束匹配的治疗选择框架。将软骨修复视为关节保留策略的连续谱，按力学需求、生物学合理性和实践可行性分为五类：结构性表面重建与移植技术、细胞修复、骨髓刺激修复、支架增强修复及同种异体骨软骨移植。核心决策流程强调序贯评估关节环境（力线、稳定性、半月板完整性、软骨下骨）、缺损特征（大小、位置、深…
英文摘要
Focal chondral defects of the knee present a heterogeneous clinical problem with no universally applicable solution. Lesion size, containment, subchondral bone involvement, joint alignment, meniscal integrity, patient activity demands, and system-level constraints variably influence durability, yet outcomes are often interpreted without adequate contextualization. As a result, treatment comparisons frequently reflect differences in indication rather than superiority of technique. This review proposes a constraint-based framework to guide treatment selection in focal knee chondral defects. Cartilage restoration is conceptualized as a continuum of joint-preserving strategies, each occupying a defined role determined by mechanical demands, biologic plausibility, and practical feasibility. Available interventions are organized into five categories: structural resurfacing and transfer techniques, cell-based repair, marrow stimulation-based repair, scaffold-augmented repair, and osteochondral allograft transplantation. A structured decision algorithm is presented emphasizing sequential evaluation of the joint environment, defect characteristics, and patient-specific modifiers. The framework emphasizes that malalignment, instability, meniscal deficiency, and subchondral bone pathology must be addressed to optimize durability, and that lesion geometry and depth narrow the range of biologically and mechanically plausible options. Patient expectations and system constraints refine, but do not override, lesion-driven decision-making. Rather than positioning techniques hierarchically, this model highlights appropriate application boundaries and expected trade-offs. Durable symptom relief and delay of arthroplasty remain shared endpoints across modalities. By shifting emphasis from modality comparison to constraint matching, this framework provides a unified structure for interpreting the cartilage restoration literature and establishes the foundation for the modality-specific analyses presented in subsequent parts of this series.