Traumatology and Orthopedics of Russia

Травматология и ортопедия России

2311-29052542-0933

Vreden National Medical Research Center of Traumatology and Orthopedics

1492

10.21823/2311-2905-2020-26-3-170-181

Reviews

Обзоры

Reviews

The Effectiveness of Various Surgical Techniques in the Treatment of Local Knee Cartilage Lesions (Review)

Эффективность различных хирургических методик при лечении локальных повреждений хряща коленного сустава (обзор литературы)

https://orcid.org/0000-0003-3175-4756

Kulyaba

T. A.

Куляба

Т. А.

Russian Federation

Taras A. Kulyaba — Dr. Sci. (Med.), Head of the Knee Pathology Department

St. Petersburg

Куляба Тарас Андреевич — д-р мед. наук, руководитель научного отделения патологии коленного сустава

Санкт-Петербург

https://orcid.org/0000-0002-7291-7032

Bantser

S. A.

Банцер

С. А.

Russian Federation

Sergei A. Bantser — Cand. Sci. (Med.), Lecturer, Chair of Traumatology and Orthopedics

St. Petersburg

Банцер Сергей Александрович — канд. мед. наук, преподаватель кафедры травматологии и ортопедии

Санкт-Петербург

serg249_spb@mail.ru

Trachuk

P. A.

Трачук

П. А.

Russian Federation

Pavel A. Trachuk – Doctor

St. Petersburg

Трачук Павел Александрович — врач

Санкт-Петербург

https://orcid.org/0000-0002-4594-6655

Vorontsova

T. N.

Воронцова

Т. Н.

Russian Federation

Tatyana N. Vorontsova — Dr. Sci. (Med.), Head of Organization and Methodological Department

St. Petersburg

Воронцова Татьяна Николаевна — д-р мед. наук, руководитель организационно-методического отдела

Санкт-Петербург

https://orcid.org/0000-0001-6905-7900

Kornilov

N. N.

Корнилов

Н. Н.

Russian Federation

Nikolai N. Kornilov — Dr. Sci. (Med.), Professor, Chair of Traumatology and Orthopedics, Head of Knee Surgery Department, Vreden National Medical Research Center of Traumatology and Orthopedics; Assistant Professor, Department of Traumatology and Orthopedics, Mechnikov North-Western State Medical University

St. Petersburg

Корнилов Николай Николаевич — д-р мед. наук, профессор кафедры травматологии и ортопедии, ФгБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Р.Р. Вредена» Минздрава России; доцент кафедры травматологии и ортопедии, ФгБУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России

Санкт-Петербург

Vreden National Medical Research Center of Traumatology and OrthopaedicsФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Р.Р. Вредена» Минздрава России

Pavlov First Saint-Petersburg State Medical UniversityФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. И.П. Павлова» Минздрава России

Mechnikov North-Western State Medical UniversityФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России

29092020

263

1701811007202028072020

https://journal.rniito.org/jour/article/view/1492

Introduction. To restore the knee local cartilage lesions, a large number of alternative surgical techniques are used in clinical practice: isolated debridement of the lesion area, chondrogenesis stimulation, mosaic osteochondral grafting, cell technologies, collagen membranes (matrices), and a combination of the above methods. The purpose of this article was to compare the effectiveness of various surgical methods of treating patients with local cartilage lesions of the femur based on analysis of relevant publications. Materials and Methods. The review included 85 publications of domestic and foreign authors within 2005 to 2020. The search was carried out in electronic scientific databases PubMed and eLIBRARy. Results. The medium and long term outcomes of debridement and/or various options of chondrogenesis stimulating, despite their wide popularity, in terms of clinical, radiological, and histological indicators, are inferior to all other surgical techniques. Mosaic osteochondral auto- and/or allografting, as well as transplantation of autologous chondrocytes culture with a collagen membrane, are characterized by the best 15 to 20-year outcomes, allowing most patients to maintain the same level of activity as before the lesion occurred. The combination of matrices with other cellular products or microfracturing shows similar medium-term results, but it long-term efficacy remains unknown. Conclusion. The use of debridement and/or chondrogenesis stimulation should be limited to minimal defects. From both a clinical and an economic point of view, mosaic osteochondral grafting is the optimal method for the treatment of knee local cartilage lesions with an area up to 4 to 6 cm² . The combination of membranes with various cellular products or microfracturing is indicated in case of extensive local cartilage lesions or if mosaic osteochondral grafting is not appropriate.

Введение. Для восстановления локальных повреждений хряща (ЛПХ) коленного сустава в клинической практике применяется большое количество альтернативных хирургических подходов: изолированый дебридмент зоны повреждения, стимуляция хондрогенеза, мозаичная костно-хрящевая пластика (МКХА), клеточные технологии, коллагеновые мембраны (матрицы) и комбинация вышеупомянутых методик. Цель исследования — сравнить эффективность различных хирургических методов лечения пациентов с ЛПХ бедренной кости на основании контент-анализа публикаций. Материал и методы. В обзор вошли 85 работ отечественных и зарубежных авторов за период с 2005 по 2020 г. Поиск проводился в электронных научных базах данных PubMed и eLIBRARy. Результаты. Дебридмент и/или различные варианты стимуляции хондрогенеза, несмотря на широкую популярность, в средне- и долгосрочной перспективе клинико-рентгенологически и гистологически уступают всем остальным хирургическим методикам. Мозаичная костно-хрящевая ауто- и/или аллопластика, а также пересадка культуры аутологичных хондроцитов с коллагеновой мембраной характеризуются наилучшими 15–20-летними исходами, позволяя большинству пациентов сохранять такой же уровень активности как и до повреждения. Комбинация матриц с другими клеточными продуктами или микрофрактурингом демонстрирует схожие среднесрочные результаты, но их отдаленная эффективность продолжает оставаться неизвестной. Заключение. Применение дебридмента и/или стимуляции хондрогенеза следует ограничить минимальными по площади дефектами. МКХА является оптимальным методом выбора лечения ЛПХ площадью до 4–6 см² как с клинической, так и с экономической точки зрения. Комбинация мембран с различными клеточными продуктами или микропереломами показана при обширных ЛПХ или при невозможности проведения МКХА.

knee jointlocal cartilage lesionsmicrofracturingcollagen membranes

коленный суставлокальные повреждения хрящамикрофрактурингколлагеновые мембраны

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