Cartilage Restoration of Bipolar Lesions Within the Patellofemoral Joint Delays Need for Arthroplasty: A Systematic Review of Rates of Failure

Abstract

The purpose of the present review is to systematically review the available literature for failure rates and complications of cartilage restoration of bipolar chondral defects in the patellofemoral (PF) joint to assess the ability to treat these lesions without arthroplasty. Methods: PubMed and MEDLINE databases were queried between 2000 to 2020 using the keywords "osteochondral" and "knee" and "microfracture," "autologous chondrocyte implantation (ACI)," or "transplantation." Patient selection included patients with bipolar chondral lesions of the patellofemoral joint that were treated with cartilage restoration procedures. Treatment of PF joints were reviewed for surgical indications/technique, rates of failure, defect characteristics, and time to failure. For the purposes of this study, failure was defined by each individual author on their respective studies. Results: After screening 1,295 articles, there were 8 publications analyzed quantitatively and 10 articles analyzed both quantitatively and qualitatively. A total of 249 knees involved bipolar lesions of the patellofemoral joint. The weighted average age was 36.5 AE 10.4 years, and weighted average follow-up was 89.0 AE 31.7 months. There were failures in 0% to 50% of cases, revision procedures in 0% to 10% of cases, conversion to arthroplasty in in 0% to 50% of cases, and unsatisfactory outcome without revision in 0% to 8.3% of cases. The range in average failure rate was 0% to 50.0% (I 2 ¼ 68.0%), whereas the range in average time to failure was 2.9 to 6.8 years (I 2 ¼ 79.0%). Conclusion: From the available data, established cartilage restoration procedures may provide favorable patient-reported function, avoidance of secondary surgery, and joint preservation in at least 80% of patients at short-to mid-term follow-up. Level of Evidence: Level IV, systematic review of Level IV studies.

Treatment of Cartilage Defects of the Knee in Military Tactical Athletes: An Overview of Management and Clinical Outcomes

“…Gowd et al found that across all cartilage restoration treatments, the majority of patients did not require conversation to an arthroplasty at short- to long-term follow-up, and, even in the cases of those who did, the need for an arthroplasty was delayed 2.8 to 5.5 years. 4 5…”

“…Gowd et al found that across all cartilage restoration treatments, the majority of patients did not require conversation to an arthroplasty at short-to longterm follow-up, and, even in the cases of those who did, the need for an arthroplasty was delayed 2.8 to 5.5 years. 4,5 The available literature has clearly demonstrated that cartilage restoration procedures can be performed safely with minimal complication rates, and associated with substantial improvements in patients' pain and function. 6 Among athletes undergoing cartilage restoration procedures, relatively high rates of success with an overall return to preinjury level of sport rate of 66% have been observed.…”