BACKGROUND Focal cartilage lesions (FCLs) are frequently found during knee arthroscopies and may impair quality of life (QoL) significantly. Several treatment options with good short-term results are available, but the natural history without any treatment is largely unknown. The aim of this study was to evaluate patient-reported outcome measures (PROMs), the need for subsequent cartilage surgery, and the risk of treatment failure 20 years after diagnosis of an FCL in the knee. METHODS Patients undergoing any knee arthroscopy for an FCL between 1999 and 2012 in 6 major Norwegian hospitals were identified. Inclusion criteria were an arthroscopically classified FCL in the knee, patient age of ≥18 years at surgery, and any preoperative PROM. Exclusion criteria were lesions representing knee osteoarthritis or "kissing lesions" at surgery. Demographic data, later knee surgery, and PROMs were collected by questionnaire. Regression models were used to adjust for and evaluate the factors impacting the long-term PROMs and risk factors for treatment failure (defined as knee arthroplasty, osteotomy, or a Knee injury and Osteoarthritis Outcome Score-Quality of Life [KOOS QoL] subscore of <50). RESULTS Of the 553 eligible patients, 322 evaluated patients (328 knees) were included and analyzed. The mean follow-up was 19.1 years, and the mean age at index FCL surgery was 36.8 years (95% confidence interval [CI], 35.6 to 38.0 years). The patients without knee arthroplasty or osteotomy had significantly better mean PROMs (pain, Lysholm, and KOOS) at the time of final follow-up than preoperatively. At the time of follow-up, 17.7% of the knees had undergone subsequent cartilage surgery. Nearly 50% of the patients had treatment failure, and the main risk factors were a body mass index of ≥25 kg/m 2 (odds ratio [OR] for overweight patients, 2.0 [95% CI, 1.1 to 3.6]), >1 FCL (OR, 1.9 [CI, 1.1 to 3.3]), a full-thickness lesion (OR, 2.5 [95% CI, 1.3 to 5.0]), and a lower level of education (OR, 1.8 [95% Cl, 1.1 to 2.8]). Autologous chondrocyte implantation (ACI) was associated with significantly higher KOOS QoL, by 17.5 (95% CI, 3.2 to 31.7) points, and a lower risk of treatment failure compared with no cartilage treatment, microfracture, or mosaicplasty. CONCLUSIONS After a mean follow-up of 19 years, patients with an FCL who did not require a subsequent knee arthroplasty had significantly higher PROM scores than preoperatively. Nonsurgical treatment of FCLs had results equal to those of the surgical FCL treatments except for ACI, which was associated with a better KOOS and lower risk of treatment failure. Full-thickness lesions, >1 FCL, a lower level of education, and a greater BMI were the main risk factors associated with poorer results. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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关节镜验证的膝关节局灶性软骨病变的长期结果：一项为期 19 年的多中心随访和患者报告的结果。


背景 局灶性软骨病变 （FCL） 经常在膝关节镜检查中发现，并可能严重损害生活质量 （QoL）。有几种短期效果良好的治疗方案可供选择，但没有任何治疗的自然病程在很大程度上是未知的。本研究的目的是评估患者报告的结果测量 （PROM）、后续软骨手术的必要性以及诊断为膝关节 FCL 后 20 年治疗失败的风险。方法 确定了 1999 年至 2012 年间在挪威 6 家主要医院接受任何膝关节镜检查 FCL 的患者。纳入标准是膝关节镜分类的 FCL、手术时患者年龄 ≥18 岁以及任何术前 PROM。排除标准是代表膝骨关节炎或手术时 “接吻病灶” 的病变。通过问卷调查收集人口统计数据、后来的膝关节手术和 PROM。使用回归模型来调整和评估影响长期 PROM 的因素和治疗失败的危险因素（定义为膝关节置换术、截骨术或膝关节损伤和骨关节炎结果评分-生活质量 [KOOS QoL] 子评分 <50）。结果 在 553 例符合条件的患者中，纳入并分析了 322 例评估患者 （328 个膝关节）。平均随访时间为 19.1 年，指数 FCL 手术的平均年龄为 36.8 岁 （95% 置信区间 [CI]，35.6 至 38.0 岁）。无膝关节置换术或截骨术的患者在最终随访时的平均 PROMs （疼痛、Lysholm 和 KOOS） 显著优于术前。在随访时，17.7% 的膝关节接受了随后的软骨手术。 近 50% 的患者治疗失败，主要危险因素为体重指数为 ≥25 kg/m 2（超重患者的比值比 [OR]，2.0 [95% CI，1.1 至 3.6]）、>1 FCL（OR，1.9 [CI，1.1 至 3.3]）、全层病变（OR，2.5 [95% CI，1.3 至 5.0]）和较低的教育水平（OR， 1.8 [95% Cl，1.1 至 2.8]）。自体软骨细胞植入 （ACI） 与 KOOS QoL 显著升高 17.5 （95% CI，3.2 至 31.7） 分相关，与无软骨治疗、微骨折或镶嵌成形术相比，治疗失败的风险较低。结论 平均随访 19 年后，不需要后续膝关节置换术的 FCL 患者的 PROM 评分显著高于术前。FCL 的非手术治疗结果与手术 FCL 治疗的结果相同，但 ACI 除外，ACI 与更好的 KOOS 和更低的治疗失败风险相关。全层病变、>1 FCL、较低的教育水平和较高的 BMI 是与较差结果相关的主要危险因素。证据级别 治疗级别 III .有关证据级别的完整描述，请参阅作者说明。