{"title":"软骨缺损的各种治疗方法与微骨折术的临床疗效对比:随机对照试验的网络荟萃分析","authors":"Sathish Muthu , Vibhu Krishnan Viswanathan , Girinivasan Chellamuthu , Mohammad Thabrez","doi":"10.1016/j.jcjp.2023.100163","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Advancements have been made in the realm of cartilage-regenerative techniques in the past decades. However, their comparative advantage has not yet been fully studied.</p></div><div><h3>Objectives</h3><p>To comparatively analyze the functional, radiological and histological outcomes, and complications of various procedures available for the treatment of cartilage defects.</p></div><div><h3>Data sources</h3><p>PubMed, Embase, Web of Science, Cochrane, and Scopus.</p></div><div><h3>Study eligibility criteria, participants, and interventions</h3><p>Randomized controlled trials reporting functional, radiological, histological outcomes, or complications of various methods were utilized in the management of cartilage defects. Patients with cartilage defects. Treatment methods include microfracture (MFX), autologous chondrocyte implantation (ACI), osteochondral allograft/autograft transplantation (OAT), mosaicplasty, or acellular implants.</p></div><div><h3>Study appraisal and synthesis methods</h3><p>Cochrane’s Confidence in Network meta-analysis approach. Network meta-analysis was conducted in Stata. Random effects model was used for forest plots.</p></div><div><h3>Results</h3><p>Three thousand one hundred ninety-three patients from 54 randomized controlled trials were included in the analysis. The mean age of included patients was 37.9 (±9.46) years. MFX-I was used as a constant comparator. Among the restorative methods, OAT-II offered significantly better functional outcome at 5 years (weighted mean difference [WMD] = 16.00, 95% confidence interval [CI] [11.66, 20.34], <em>P</em> < .001) and 10 years (WMD = 16.00, 95% CI [10.42, 21.58], <em>P</em> < .001), while OAT-I offered significantly better pain relief (WMD = −1.74, 95% CI [−3.45, −0.02], <em>P</em> = .042), and retained hyaline histology (odds ratio = 8.12, 95% CI [4.17, 12.07], <em>P</em> = .001) at 1 year with least-reported adverse events and failures. Among the regenerative methods, MFX-III (WMD = −10.0, 95% CI [−13.07, −6.93], <em>P</em> = .008) offered significantly better functional outcomes at 5 years, while ACI-III (odds ratio = 0.89, 95% CI [0.03, 1.76], <em>P</em> = .032) demonstrated significantly better radiological outcomes at 2 years.</p></div><div><h3>Limitations</h3><p>Heterogeneity in reporting of diverse functional outcome measures.</p></div><div><h3>Conclusions and implications of key findings</h3><p>Compared with MFX-I, OAT-II demonstrated significantly better long-term functional outcome (10 years), while ACI-III and MFX-III demonstrated significantly better functional outcomes only till midterm (5 years), and there is a paucity of long-term data on these treatment methods.</p></div><div><h3>Systematic review registration number</h3><p>CRD42022338329.</p></div>","PeriodicalId":100760,"journal":{"name":"Journal of Cartilage & Joint Preservation","volume":"4 2","pages":"Article 100163"},"PeriodicalIF":0.0000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667254523000690/pdfft?md5=dd2499475cea1a5c66e2ed9b66356327&pid=1-s2.0-S2667254523000690-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Clinical effectiveness of various treatments for cartilage defects compared with microfracture: a network meta-analysis of randomized controlled trials\",\"authors\":\"Sathish Muthu , Vibhu Krishnan Viswanathan , Girinivasan Chellamuthu , Mohammad Thabrez\",\"doi\":\"10.1016/j.jcjp.2023.100163\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Advancements have been made in the realm of cartilage-regenerative techniques in the past decades. However, their comparative advantage has not yet been fully studied.</p></div><div><h3>Objectives</h3><p>To comparatively analyze the functional, radiological and histological outcomes, and complications of various procedures available for the treatment of cartilage defects.</p></div><div><h3>Data sources</h3><p>PubMed, Embase, Web of Science, Cochrane, and Scopus.</p></div><div><h3>Study eligibility criteria, participants, and interventions</h3><p>Randomized controlled trials reporting functional, radiological, histological outcomes, or complications of various methods were utilized in the management of cartilage defects. Patients with cartilage defects. Treatment methods include microfracture (MFX), autologous chondrocyte implantation (ACI), osteochondral allograft/autograft transplantation (OAT), mosaicplasty, or acellular implants.</p></div><div><h3>Study appraisal and synthesis methods</h3><p>Cochrane’s Confidence in Network meta-analysis approach. Network meta-analysis was conducted in Stata. Random effects model was used for forest plots.</p></div><div><h3>Results</h3><p>Three thousand one hundred ninety-three patients from 54 randomized controlled trials were included in the analysis. The mean age of included patients was 37.9 (±9.46) years. MFX-I was used as a constant comparator. Among the restorative methods, OAT-II offered significantly better functional outcome at 5 years (weighted mean difference [WMD] = 16.00, 95% confidence interval [CI] [11.66, 20.34], <em>P</em> < .001) and 10 years (WMD = 16.00, 95% CI [10.42, 21.58], <em>P</em> < .001), while OAT-I offered significantly better pain relief (WMD = −1.74, 95% CI [−3.45, −0.02], <em>P</em> = .042), and retained hyaline histology (odds ratio = 8.12, 95% CI [4.17, 12.07], <em>P</em> = .001) at 1 year with least-reported adverse events and failures. Among the regenerative methods, MFX-III (WMD = −10.0, 95% CI [−13.07, −6.93], <em>P</em> = .008) offered significantly better functional outcomes at 5 years, while ACI-III (odds ratio = 0.89, 95% CI [0.03, 1.76], <em>P</em> = .032) demonstrated significantly better radiological outcomes at 2 years.</p></div><div><h3>Limitations</h3><p>Heterogeneity in reporting of diverse functional outcome measures.</p></div><div><h3>Conclusions and implications of key findings</h3><p>Compared with MFX-I, OAT-II demonstrated significantly better long-term functional outcome (10 years), while ACI-III and MFX-III demonstrated significantly better functional outcomes only till midterm (5 years), and there is a paucity of long-term data on these treatment methods.</p></div><div><h3>Systematic review registration number</h3><p>CRD42022338329.</p></div>\",\"PeriodicalId\":100760,\"journal\":{\"name\":\"Journal of Cartilage & Joint Preservation\",\"volume\":\"4 2\",\"pages\":\"Article 100163\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2667254523000690/pdfft?md5=dd2499475cea1a5c66e2ed9b66356327&pid=1-s2.0-S2667254523000690-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cartilage & Joint Preservation\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2667254523000690\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cartilage & Joint Preservation","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2667254523000690","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景在过去的几十年中,软骨再生技术领域取得了长足的进步。数据来源PubMed、Embase、Web of Science、Cochrane 和 Scopus。研究资格标准、参与者和干预措施报告软骨缺损治疗中各种方法的功能、放射学、组织学结果或并发症的随机对照试验。软骨缺损患者。治疗方法包括微骨折(MFX)、自体软骨细胞植入(ACI)、骨软骨同种异体移植/自体移植(OAT)、镶嵌成形术或无细胞植入物。网络荟萃分析在 Stata 中进行。结果54项随机对照试验中的3,193名患者被纳入分析。纳入患者的平均年龄为 37.9 (±9.46) 岁。MFX-I被用作恒定比较者。在各种修复方法中,OAT-II 在 5 年(加权平均差 [WMD] = 16.00,95% 置信区间 [CI] [11.66, 20.34],P < .001)和 10 年(WMD = 16.00,95% CI [10.42, 21.58],P < .001),而 OAT-I 能明显更好地缓解疼痛(WMD = -1.74, 95% CI [-3.45, -0.02],P = .042),并在 1 年后保留透明组织学(几率比 = 8.12, 95% CI [4.17, 12.07],P = .001),且报告的不良事件和失败最少。在再生方法中,MFX-III(WMD = -10.0,95% CI [-13.07,-6.93],P = .008)在5年后的功能结果明显更好,而 ACI-III(几率比 = 0.89,95% CI [0.03,1.76],P = .032)在2年后的放射学结果明显更好。主要研究结果的结论和意义与MFX-I相比,OAT-II的长期功能预后(10年)明显更好,而ACI-III和MFX-III仅在中期(5年)的功能预后明显更好,这些治疗方法的长期数据很少。
Clinical effectiveness of various treatments for cartilage defects compared with microfracture: a network meta-analysis of randomized controlled trials
Background
Advancements have been made in the realm of cartilage-regenerative techniques in the past decades. However, their comparative advantage has not yet been fully studied.
Objectives
To comparatively analyze the functional, radiological and histological outcomes, and complications of various procedures available for the treatment of cartilage defects.
Data sources
PubMed, Embase, Web of Science, Cochrane, and Scopus.
Study eligibility criteria, participants, and interventions
Randomized controlled trials reporting functional, radiological, histological outcomes, or complications of various methods were utilized in the management of cartilage defects. Patients with cartilage defects. Treatment methods include microfracture (MFX), autologous chondrocyte implantation (ACI), osteochondral allograft/autograft transplantation (OAT), mosaicplasty, or acellular implants.
Study appraisal and synthesis methods
Cochrane’s Confidence in Network meta-analysis approach. Network meta-analysis was conducted in Stata. Random effects model was used for forest plots.
Results
Three thousand one hundred ninety-three patients from 54 randomized controlled trials were included in the analysis. The mean age of included patients was 37.9 (±9.46) years. MFX-I was used as a constant comparator. Among the restorative methods, OAT-II offered significantly better functional outcome at 5 years (weighted mean difference [WMD] = 16.00, 95% confidence interval [CI] [11.66, 20.34], P < .001) and 10 years (WMD = 16.00, 95% CI [10.42, 21.58], P < .001), while OAT-I offered significantly better pain relief (WMD = −1.74, 95% CI [−3.45, −0.02], P = .042), and retained hyaline histology (odds ratio = 8.12, 95% CI [4.17, 12.07], P = .001) at 1 year with least-reported adverse events and failures. Among the regenerative methods, MFX-III (WMD = −10.0, 95% CI [−13.07, −6.93], P = .008) offered significantly better functional outcomes at 5 years, while ACI-III (odds ratio = 0.89, 95% CI [0.03, 1.76], P = .032) demonstrated significantly better radiological outcomes at 2 years.
Limitations
Heterogeneity in reporting of diverse functional outcome measures.
Conclusions and implications of key findings
Compared with MFX-I, OAT-II demonstrated significantly better long-term functional outcome (10 years), while ACI-III and MFX-III demonstrated significantly better functional outcomes only till midterm (5 years), and there is a paucity of long-term data on these treatment methods.