Arthroscopic debridement for focal articular cartilage lesions of the knee: A systematic review

Totlis, Trifon; Fermín, Theodorakys Marín; Kalifis, Georgios; Terzidis, Ioannis; Maffulli, Nicola; Papakostas, Emmanouil

doi:10.1016/j.surge.2020.11.011

Cited by 21 publications

(13 citation statements)

References 39 publications

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“…There has been a great focus on various surgical methods to treat these lesions, but without understanding the basic pathophysiology of the condition, it is unlikely that an ideal surgical treatment will be found. Surgical treatment options include debridement, 15 microfracture, 16 mosaicplasty, 17 osteochondral allograft transplantation (OAT), 18 and cell-based therapies, such as autologous chondrocyte implantation (ACI). 19 Surgical treatment is often dictated by lesion size and location, and the patient’s age, general health, activity level, and symptoms.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Lesion Size on Pain and Function in Patients Scheduled for Cartilage Surgery of the Knee

2022

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Objective Despite an increased interest in treatment options for cartilage lesions of the knee, the relationship between lesion characteristics and the symptoms they elicit is not well understood. We evaluated the relationship between lesion characteristics and the patient-reported outcome measures (PROMs) and compared this with symptoms reported by patients scheduled for knee ligament reconstruction and knee arthroplasty. Design Preoperative data, including Lysholm score and The Knee Injury and Osteoarthritis Outcome Score (KOOS), in 90 consecutive patients scheduled for surgery for symptomatic isolated cartilage lesions were prospectively collected. Result The patients had a mean age of 33.2 years. There were 62 (69%) males. There was no statistically significant difference in PROMs between patients with cartilage lesions smaller or larger than 2 cm2, except for the KOOS subscale symptoms, with patients with smaller lesions reporting higher scores, 62.8 (95% confidence interval [CI] 58.3-67.3) vs. 51.9 (95% CI 45.5-58.4), P = 0.005. There was a small correlation between lesion size and Lysholm score. However, when adjusted for age, sex, body mass index, and lesion localization, this effect was not statistically significant. The International Cartilage Regeneration & Joint Preservation Society grade did not affect preoperative PROMs. Cartilage patients reported worse preoperative symptoms than patients scheduled for knee ligament reconstruction, and approaching the symptoms reported by patients scheduled for knee arthroplasty. Conclusion The size, depth, and location of cartilage lesions have little impact on the symptoms experienced by the patients. Cartilage patients have comparable symptoms to patients scheduled for knee arthroplasty.

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Section: Discussionmentioning

confidence: 99%

The Effect of Lesion Size on Pain and Function in Patients Scheduled for Cartilage Surgery of the Knee

2022

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“…It is also important that the technique be readily available and be as harmless as possible. The arthroscopic debridement although gives some good results, the studies are limited, and the evidence is low [ 7 ]. On the other hand, the cultured chondrocyte implantation provides good repair capacity but has disadvantages such as high cost, limited availability, and the need for two procedures [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical and quality-of-life outcomes of a combined synthetic scaffold and autogenous tissue graft procedure for articular cartilage repair in the knee

et al. 2022

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Background Injuries to the articular cartilage of the knee often fail to heal properly due to the hypocellular and avascular nature of this tissue. Subsequent disability can limit participation in sports and decrease quality of life. Subchondral bone perforations are used for the treatment of small defects. Filling out the central portion in larger lesions becomes difficult, and scaffolds can be used as adjuvants, providing a matrix onto which the defect can be filled in completely. Also, autogenous cartilage grafts can be combined, acting as an inducer and improving healing quality, all in a single procedure. Methods This observational study evaluated the clinical and quality-of-life outcomes of patients with articular cartilage lesions of the knee undergoing repair via a microfracture technique combined with a synthetic scaffold and autogenous cartilage graft, with transosseous sutures and fibrin glue fixation, at 12 months of follow-up. Secondarily, it assessed whether combined procedures, previous surgical intervention, traumatic aetiology, lesion location, and age affect outcomes. The sample consisted of adult patients (age 18–66 years) with symptoms consistent with chondral or osteochondral lesions, isolated or multiple, ICRS grade III/IV, 2–12 cm2 in size. Patients with corrected angular deviations or instabilities were included. Those with BMI > 40 kg/m2, prior total or subtotal (> 30%) meniscectomy, second-look procedures, and follow-up < 6 months were excluded. Pain (VAS), physical activity (IKDC), osteoarthritis (WOMAC), and general quality of life (SF-36) were assessed. Results 64 procedures were included, comprising 60 patients. There was significant improvement (P < 0.05) in VAS score (5.92–2.37), IKDC score (33.44–56.33), and modified WOMAC score (53.26–75.93) after surgery. The SF-36 showed significant improvements in the physical and mental domains (30.49–40.23 and 46.43–49.84 respectively; both P < 0.05). Conclusions Combination of microfractures, autogenous crushed cartilage graft, synthetic scaffold, and transosseous sutures with fibrin glue provides secure fixation for treatment of articular cartilage lesions of the knee. At 12-month follow-up, function had improved by 20 points on the IKDC and WOMAC, and quality of life, by 10 points on the SF-36. Age > 45 years had a negative impact on outcomes.

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“…The lesions of the disease that occur most frequently are in the knees, hips, and hands. OA is usually treated with combined therapies including medications, surgery, and exercise ( Fortin et al, 2002 ; Totlis et al, 2021 ). Medication therapy is of most importance in treating OA, which includes nonsteroidal anti-inflammatory drugs, cartilage protectants, and intra-articular injection drugs in Western medicine ( Lane and Thompson, 1997 ; Petrella and Wakeford, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Study on the Mechanism of Baimai Ointment in the Treatment of Osteoarthritis Based on Network Pharmacology and Molecular Docking with Experimental Verification

et al. 2021

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Purpose: The external preparation of the Tibetan medicine formula, Baimai ointment (BMO), has great therapeutic effects on osteoarthritis (OA). However, its molecular mechanism remains almost elusive. Here, a comprehensive strategy combining network pharmacology and molecular docking with pharmacological experiments was adopted to reveal the molecular mechanism of BMO against OA.Methods: The traditional Chinese medicine for systems pharmacology (TCMSP) database and analysis platform, traditional Chinese medicine integrated database (TCMID), GeneCards database, and DisGeNET database were used to screen the active components and targets of BMO in treating OA. A component–target (C-T) network was built with the help of Cytoscape, and the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment through STRING. Autodock Tools which was used to dock the key components and key target proteins was analyzed. Animal experiments were performed to verify the key targets of BMO. Hematoxylin–eosin and toluidine blue staining were used to observe the pathology of joints. Protein expression was determined using enzyme-linked immunosorbent assay.Results: Bioactive compounds and targets of BMO and OA were screened. The network analysis revealed that 17-β-estradiol, curcumin, licochalone A, quercetin, and glycyrrhizic acid were the candidate key components, and IL6, tumor necrosis factor (TNF), MAPK1, VEGFA, CXCL8, and IL1B were the candidate key targets in treating OA. The KEGG indicated that the TNF signaling pathway, NF-κB signaling pathway, and HIF-1 signaling pathway were the potential pathways. Molecular docking implied a strong combination between key components and key targets. The pathology and animal experiments showed BMO had great effects on OA via regulating IL6, TNF, MAPK1, VEGFA, CXCL8, and IL1B targets. These findings were consistent with the results obtained from the network pharmacology approach.Conclusion: This study preliminarily illustrated the candidate key components, key targets, and potential pathways of BMO against OA. It also provided a promising method to study the Tibetan medicine formula or external preparations.

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Arthroscopic debridement for focal articular cartilage lesions of the knee: A systematic review

Cited by 21 publications

References 39 publications

The Effect of Lesion Size on Pain and Function in Patients Scheduled for Cartilage Surgery of the Knee

The Effect of Lesion Size on Pain and Function in Patients Scheduled for Cartilage Surgery of the Knee

Clinical and quality-of-life outcomes of a combined synthetic scaffold and autogenous tissue graft procedure for articular cartilage repair in the knee

Study on the Mechanism of Baimai Ointment in the Treatment of Osteoarthritis Based on Network Pharmacology and Molecular Docking with Experimental Verification

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