前交叉韧带重建术后通过二次关节镜可发现明显的关节软骨损伤：系统综述

目的 评估前交叉韧带（anterior cruciate ligament, ACL）重建术后，关节软骨在二次关节镜下的软骨损伤情况。方法 基于PubMed和Embase两大数据库，两名研究人员独立检索2018年3月之前公开发表的关于ACL重建术后二次关节镜下软骨情况的临床研究，并对检索结果的参考文献进行了回顾性检索。两位研究者从研究设计、样本大小、手术技术等方面对所纳入文献进行质量评价，并独立地提取出各个研究的作者、发表时间、病人数量、移植物类型、手术方法、二次关节镜的发现（尤其是软骨的情况和相关影响因素）以及病人的术后表现等数据。结果 纳入10篇研究文献，共计788名在ACL重建术后进行了二次关节镜手术的病人，病人从重建手术到二次关节镜手术的平均时间为19.6个月。在所有研究中，通过二次关节镜均发现了明显的关节软骨退行性改变，以关节软骨的软化和纤维化最为常见；在不同区域的关节软骨中，以髌股关节的软骨损伤最为常见。可能影响ACL重建术后关节软骨改变的因素无确定结论，但多个研究证明半月板的完整性与软骨损伤有关。结论 ACL重建术后，通过二次关节镜，可以发现明显的以软骨的软化和纤维化为主要表现的退行性关节软骨改变，其中髌股关节软骨最易受影响；半月板的不完整可能是关节软骨损害的危险因素之一。

Significant degeneration of articular cartilage can be found by second-look arthroscopy after anterior cruciate ligament reconstruction: A systematic review

Objective To evaluate the articular cartilaginous change after anterior cruciate ligament (ACL) reconstruction under second-look arthroscopy. Methods Electronic search for the public clinical research of the articular cartilaginous change after ACL reconstruction under second-look arthroscopy based on PubMed and Embase was performed at March 2018. Besides, reference lists of previous published articles were also reviewed. Two researchers evaluate the quality of the literature from the aspects of research design, sample size, and surgical techniques, and the details of the authors, published time, number of patients, graft types, operative methods, second-look arthroscopy findings, especially cartilage condition and related factors, and postoperative performance were independently extracted. Results Ten studies met the inclusion criteria, across which 788 patients underwent second-look arthroscopy after ACL reconstruction. The mean time from surgery to second-look arthroscopy was 19.6 months. The degenerative changes of articular cartilage could be found with the use of second-look arthroscopy in all studies, even if ACL reconstruction can restore the stability of the injured knee in most patients. Softening or fibrillation of articular cartilage was most commonly observed at second-look arthroscopy, and cartilage lesion in patellofemoral joint was most frequently observed. Potential risk factors influencing cartilage damage were identified with inconsistent results, and some studies showed significant correlation between integrity of meniscus and cartilage damage. Conclusion Significant degeneration of articular cartilage after ACL reconstruction can be found by second-look arthroscopy, patellofemoral joint cartilage might be most frequently affected, and softening or fibrillation of articular cartilage was most commonly observed at second-look arthroscopy. The specific risk factors related to cartilage damages are still unclear, and the integrity of meniscus may be important.