前交叉韧带（ACL）损伤运动员并发软骨损伤的治疗选择

摘要(中文译文)

急性前交叉韧带（ACL）撕裂在运动员中很常见，经常伴有软骨损伤，这会显著影响膝关节功能并恢复运动结果。与非专业运动员相比，职业运动员ACL损伤并伴有软骨损伤的患病率更高。ACL损伤并发软骨损伤的管理需要仔细考虑手术与非手术治疗、时间、手术技术和软骨受累程度。本研究的目的是回顾和比较ACL损伤运动员并发软骨损伤的治疗策略，重点是恢复运动结果、功能结果和长期耐久性。非手术措施包括非甾体抗炎药（NSAIDs）、物理治疗和活动调节。手术管理策略专为高要求运动员量身定制，并已证明其结果有所改善，恢复运动率与积极的功能恢复一致。关节镜清理术可短期缓解症状，而微骨折可修复纤维软骨，但长期耐用性和恢复运动率较低。骨软骨自体移植（OAT）和骨软骨同种异体移植（OCA）技术可恢复透明软骨，并显示出优越的功能结果和更高的运动恢复率，特别是对于较大的缺陷。基于细胞的疗法，包括自体软骨细胞植入（ACI）和基质诱导的ACI（MACI），结合ACL重建（ACLR），与改善症状性软骨损伤的临床结果有关，其结果与单独手术相当。基于细胞的疗法限制了对软骨下骨板的损伤，但确实需要修复组织的成熟才能有效。胫骨高位或股骨远端截骨术（DFO）等手术可以纠正错位，提高移植物和软骨的耐用性。富血小板血浆（PRP）或骨髓吸出物浓缩物（BMAC）的生物增强是一种新兴的策略，可以增强软骨愈合和患者报告的结果（PROM）。在这些治疗方式中，与其他手术选择（包括清创术和微骨折）相比，OAT和OCA手术显示出最快的运动恢复率。接受OAT和ACI治疗的患者的长期耐受性最高。总的来说，治疗ACL损伤运动员的软骨损伤需要个体化的策略，以平衡功能恢复、修复的持久性和恢复比赛的时间，并采用不断发展的技术来改善长期结果和关节保护。

Abstract

Acute anterior cruciate ligament (ACL) tears are common in athletes and frequently occur with concomitant cartilage injuries, which can significantly impact knee function and return-to-sport outcomes. Professional athletes have a higher prevalence of ACL injuries with associated chondral lesions, compared with nonprofessional athletes. Management of ACL injuries with concurrent cartilage damage requires careful consideration of operative versus nonoperative treatment, timing, surgical technique, and the extent of cartilage involvement. The objective of this study is to review and compare treatment strategies for concomitant chondral lesions in ACL-injured athletes, with emphasis on return-to-sport outcomes, functional results, and long-term durability. Nonoperative measures include nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and activity modification. Surgical management strategies are tailored to high-demand athletes and have demonstrated improved outcomes with return-to-sport rates consistent with positive functional recovery. Arthroscopic debridement offers short-term symptom relief, while microfracture provides fibrocartilage repair but demonstrates lower long-term durability and return-to-sport rates. Osteochondral autograft transplantation (OAT) and osteochondral allograft transplantation (OCA) techniques restore hyaline cartilage and show superior functional outcomes and higher return-to-sport rates, particularly for larger defects. Cell-based therapies, including autologous chondrocyte implantation (ACI) and matrix-induced ACI (MACI), combined with ACL reconstruction (ACLR), have been associated with improved clinical results for symptomatic chondral lesions, with comparable outcomes to isolated procedures. Cell-based therapies limit damage to the subchondral bone plate but do require maturation of the repair tissue to be effective. Procedures such as high tibial or distal femoral osteotomy (DFO) correct malalignment and can improve graft and cartilage durability. Biologic augmentation with platelet-rich plasma (PRP) or bone marrow aspirate concentrate (BMAC) represents an emerging strategy to enhance cartilage healing and patient-reported outcomes (PROMs). Of these treatment modalities, OAT and OCA procedures demonstrated the fastest return-to-sport rates when compared with other surgical options, including debridement and microfracture. Long-term durability was highest in patients treated with OAT and ACI. Overall, treatment of chondral lesions in ACL-injured athletes requires individualized strategies that balance functional recovery, durability of repair, and timing of return to play, with evolving techniques that demonstrate trends toward improved long-term outcomes and joint preservation.

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