Bipolar Lesions of the Knee Are Associated With Inferior Clinical Outcome Following Articular Cartilage Regeneration. A Propensity Score-Matched Analysis Including 238 Patients of the German Cartilage Registry (KnorpelRegister DGOU)

Bumberger, Alexander; Seiferth, Nick; Angele, Peter; Faber, Svea; Zellner, Johannes; Niemeyer, Philipp

doi:10.1016/j.arthro.2023.02.024

Cited by 10 publications

(4 citation statements)

References 33 publications

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“…Thus, the authors concluded that patients with bipolar lesions should not be excluded from cartilage repair surgery. 11 In the present analysis, partial-thickness cartilage lesions of the corresponding joint surface were tolerated in 32.7% and full-thickness cartilage lesions in 6.8% of cases. In conclusion, corresponding partial-thickness cartilage lesions are generally accepted, while full-thickness cartilage lesions might still be a restraint for cartilage repair surgery.…”

Section: Discussionmentioning

confidence: 43%

“…5 Recent publications leave open the extent to which this strict indication has been revised, but in the meantime the majority of treated cartilage defects are degenerative in origin. 41 Further studies have also shown cartilage repair surgery has been shown to be beneficial for patients who are tobacco users, 8 older, 17 and have bipolar cartilage lesions 11 despite these being considered contraindications Lesion size is the main parameter used to determine the best technique for cartilage repair. A recently published overview article provides a treatment algorithm that differentiates between chondral and osteochondral lesions and favors bone marrow stimulation (BMS) and associated techniques for the treatment of smaller cartilage lesions, while autologous chondrocyte implantation (ACI) is recommended for larger lesions.…”

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confidence: 99%

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Factors Affecting Choice of Surgical Treatment of Cartilage Lesions of the Knee: An Analysis of Data From 5143 Patients From the German Cartilage Registry (KnorpelRegister DGOU)

Gebhardt,

Vollmer,

Zimmerer

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Symptomatic full-thickness cartilage lesions of the knee joint are considered an indication for cartilage repair surgery. Patient- and lesion-specific factors like age, nutritional status, etiology of defect, or integrity of corresponding joint surface remain controversial in indicating cartilage repair surgery. Furthermore, the selection of the most suitable cartilage repair technique for a specific cartilage lesion remains debatable. Purpose: To evaluate indications and choice of treatment method for cartilage repair surgery, depending on patient- and lesion-specific data from the German Cartilage Registry. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 6305 consecutive patients who underwent cartilage repair surgery of the knee evaluated and 5143 complete datasets were included in the analysis (follow-up rate, 81.5%). Patient-specific (age, body mass index, smoking status, previous operations, clinical leg axis) and lesion-specific (size, grading, location, etiology) data were provided by the attending surgeon at the time of surgery. Appropriate statistical tests were used to compare data depending on type and normality of data. Multivariable logistic regressions were calculated to investigate independent factors for the choice of specific cartilage repair techniques. Results: The median size of treated cartilage lesions was 3.6 cm2, and most defects were of degenerative origin (54.8%). Of the registered patients, 39.2% were categorized as overweight and 19.6% as obese, while 23.3% were smokers. The most prevalently documented operative techniques were the autologous chondrocyte implantation (ACI) (52.4%), bone marrow stimulation (BMS) (17.3%), and BMS augmented with collagen scaffolds (9.3%). Independent factors that made the use of ACI more likely were bigger lesion size, previous surgery at the joint, and lesions located at the trochlea or the patella. On the contrary, BMS or augmented BMS were preferred in older patients, with damaged corresponding joint surface, and with more concomitant surgeries. Conclusion: Cartilage repair surgery was indicated irrespective of nutritional status, smoking status, or etiology of the treated lesion. ACI was the most prevalent technique and was preferred for younger patients and patellar lesions. While older patients with degenerative changes to the joint were not excluded from cartilage repair surgery, the use of ACI was restricted.

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Section: Discussionmentioning

confidence: 43%

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Factors Affecting Choice of Surgical Treatment of Cartilage Lesions of the Knee: An Analysis of Data From 5143 Patients From the German Cartilage Registry (KnorpelRegister DGOU)

Gebhardt,

Vollmer,

Zimmerer

et al. 2024

Orthopaedic Journal of Sports Medicine

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“…First, we reported the KOOS and the change in KOOS (ΔKOOS) over time in the matched groups. Subsequently, the KOOS subgroups and their change from preoperative values (ΔKOOS-Subgroup) were calculated and compared between the groups at different time points [3]. The recently published Patient Acceptable Symptomatic State (PASS) for the KOOS subscores and the minimal clinically important difference (MCID) were used to evaluate the KOOS and ΔKOOS subgroups respectively, at 12 and 24 months [5,27].…”

Section: Outcome Measuresmentioning

confidence: 99%

The role of autologous bone grafting in matrix‐associated autologous chondrocyte implantation at the knee: Results from the German Cartilage Registry (KnorpelRegister DGOU)

Weishorn,

Tischer,

Niemeyer

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo investigate whether concomitant autologous bone grafting adversely affects clinical outcome and graft survival after matrix‐associated autologous chondrocyte implantation (M‐ACI).MethodsThe present study examines registry data of patients who underwent M‐ACI with or without autologous bone grafting for large‐sized chondral or osteochondral defects. Propensity score matching was performed to exclude potential confounders. A total of 215 patients with similar baseline characteristics were identified. Clinical outcome was assessed at the time of surgery and at 6, 12, 24, 36 and 60 months using the Knee Injury and Osteoarthritis Outcome Score (KOOS). KOOS change, clinical response rate, KOOS subcomponents and failure rate were determined.ResultsPatients treated with M‐ACI and autologous bone grafting achieved comparable clinical outcomes compared with M‐ACI alone. At 24 months postoperatively, the patient‐reported outcome (PRO) of patients treated with M‐ACI and autologous bone grafting was even significantly better as measured by KOOS (74.9 ± 18.8 vs. 79.2 ± 15.4; p = 0.043). However, the difference did not exceed the minimal clinically important difference (MCID). In patients with M‐ACI and autologous bone grafting, a greater change in KOOS relative to baseline was observed at 6 (9.3 ± 14.7 vs. 15.0 ± 14.7; p = 0.004) and 12 months (12.6 ± 17.2 vs. 17.7 ± 14.6; p = 0.035). Overall, a high clinical response rate was observed in both groups at 24 months (75.8% vs. 82.0%; p = n.s.). The estimated survival at the endpoint of reoperation for any reason was 82.1% (SD 2.8) at 8.4 years for isolated M‐ACI and 88.7% (SD 2.4) at 8.2 years for M‐ACI with autologous bone grafting (p = 0.039).ConclusionsEven in the challenging cohort of large osteochondral defects, the additional treatment with autologous bone grafting leads to remarkably good clinical outcomes in patients treated with M‐ACI. In fact, they tend to benefit more from surgery, have lower revision rates and achieve clinical response rates earlier. Subchondral bone management is critical to the success of M‐ACI and should be addressed in the treatment of borderline defects.Level of EvidenceLevel III.

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Hydrogel‐based and spheroid‐based autologous chondrocyte implantation of the knee show similar 2‐year functional outcomes: An analysis based on the German Cartilage Registry (KnorpelRegister DGOU)

Bumberger,

Niemeyer,

Angele

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo compare short‐term patient‐reported outcomes (PRO) of two contemporary matrix‐associated autologous chondrocyte implantation (M‐ACI) products for the treatment of large articular cartilage defects of the knee.MethodsA retrospective, registry‐based, matched‐pair analysis was performed, comparing PRO of patients undergoing isolated M‐ACI with either Spherox™, a spheroid‐based ACI (Sb‐ACI), or NOVOCART™ Inject, a hydrogel‐based ACI product (Hb‐ACI), for a focal full‐thickness cartilage defect of the knee ≥4 cm2. Matching parameters included age, sex, body mass index, defect size, defect localization, symptom duration and previous surgeries. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) score were obtained up to the 24‐month follow‐up. The total KOOS response rate and percentage of patients attaining a substantial clinical benefit (SCB) in KOOS subscores were calculated.ResultsA total of 45 patients per group were matched. The response rate after 24 months was not significantly different between the groups (Sb‐ACI 64.4% vs. Hb‐ACI 82.2%, p = 0.057). The number of patients with a SCB at 24 months was not significantly different in any KOOS subscore, despite significantly higher improvement of the total KOOS (14.8 ± 16.2 vs. 21.5 ± 15.4, p = 0.047) and KOOS pain in the Hb‐ACI group (12.2 ± 18.6 vs. 20.6 ± 19.1, p = 0.037). The IKDC score in the Hb‐ACI group was significantly higher at the 12‐ and 24‐month follow‐up (60.7 ± 20.2 vs. 70.9 ± 18.0, p = 0.013).ConclusionThe response rate and number of patients achieving an SCB were not significantly different between patients treated with Sb‐ACI or Hb‐ACI. Both procedures can achieve favourable 2‐year PRO. Hb‐ACI was associated with better PRO between 1 and 2 years postoperatively; however, the clinical relevance of this benefit is yet to be proven.Level of EvidenceIII, Retrospective comparative study.

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Bipolar Lesions of the Knee Are Associated With Inferior Clinical Outcome Following Articular Cartilage Regeneration. A Propensity Score-Matched Analysis Including 238 Patients of the German Cartilage Registry (KnorpelRegister DGOU)

Cited by 10 publications

References 33 publications

Factors Affecting Choice of Surgical Treatment of Cartilage Lesions of the Knee: An Analysis of Data From 5143 Patients From the German Cartilage Registry (KnorpelRegister DGOU)

Factors Affecting Choice of Surgical Treatment of Cartilage Lesions of the Knee: An Analysis of Data From 5143 Patients From the German Cartilage Registry (KnorpelRegister DGOU)

The role of autologous bone grafting in matrix‐associated autologous chondrocyte implantation at the knee: Results from the German Cartilage Registry (KnorpelRegister DGOU)

Hydrogel‐based and spheroid‐based autologous chondrocyte implantation of the knee show similar 2‐year functional outcomes: An analysis based on the German Cartilage Registry (KnorpelRegister DGOU)

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