Osteochondral Autologous Ransplantation And Microfracture In Cartilage Of The Knee:a Systematic Review

BACKGROUND: Currently,it has been reported that osteochondral autologous ransplantation is superior to microfracture surgery in the treatment of articular cartilage defects of the knee in some aspects,but there is still no evidence-based medical evidence to compare the advantages and disadvantages of the two surgical methods.OBJECTIVE: To integrate the data of existing clinical studies and conduct a scientific and systematic analysis to determine whether osteochondral autologous ransplantation is superior to microfracture in improving clinical function.The quality of all included literatures was evaluated,and the efficacy of two surgical procedures in repairing knee cartilage injury was evaluated by Cochrane Handbook.METHODS: PUBMED,EMBASE,Cochrane Register,China National Knowledge Infrastructure(CNKI),wanfang database,and China Biology Medicine(CBM)were searched from database establishment to December 2019.Literature on the treatment of articular cartilage defects with osteochondral autologous ransplantation and microfracture was collected,and the literature was screened according to inclusion andexclusion criteria and the quality was evaluated.Meta analysis was performed using RevMan 5.3 software.RESULTS AND CONCLUSIONS: A total of 8 eligible articles were included,including 4 randomized controlled studies and 4 cohort studies.A total of 262 patients in the microfracture group and 277 patients in the transplantation group were followed up for more than one year.Compared with the final follow-up Lysholm score(MD=-5.36,95%CI:-11.89~1.17,P=0.11)and HSS score(MD=-5.79,95%CI:-6.91~4.67,P < 0.00001),osteochondral autologous ransplantation can better improve the patients’ clinical function than microfracture surgery.The results confirmed that osteochondral autologous ransplantation can bring more stable and long-term clinical functions,and can achieve better pain relief and function improvement than microfracture surgery to a large extent.However,due to the limited number of randomized controlled trials and insufficient number of cases in this study,the universality of this study is limited,and larger sample size and higher quality studies are needed to confirm the long-term effectiveness of the two surgical methods.