Do Focal Chondral Defects of the Knee Increase the Risk for Progression to Osteoarthritis? A Review of the Literature

Abstract

Background:Focal chondral defects (FCDs) of the knee are believed to contribute to the development of osteoarthritis (OA), resulting in pain and dysfunction.Purpose:To investigate whether untreated FCDs of the knee progress to radiographically evident OA over time.Study Design:Systematic review; Level of evidence, 3.Methods:A literature review was performed by searching the PubMed, Embase, and Cochrane Library databases to locate studies evaluating clinical and/or radiological outcomes of patients with FCDs that were diagnosed by arthroscopic surgery or magnetic resonance imaging (MRI) and were left untreated with a minimum 2-year follow-up. Additionally, studies were included if there was a radiographic assessment of OA. Search terms used were “knee,” “focal,” “isolated,” “chondral,” “cartilage,” and “osteoarthritis.” Studies were evaluated based on clinical/radiological outcomes and OA risk factors. The study methodology was assessed using the modified Coleman Methodology Score.Results:Eight studies comprising 1425 knees met the inclusion criteria. All studies were of level 3 evidence. The risk of incident cartilage damage (enlargement of original FCDs or incidence of additional FCDs) at latest follow-up was assessed in 3 studies, while 1 study only reported the incidence of cartilage damage at follow-up. All 4 studies noted an increased progression of cartilage damage at follow-up. The progression of cartilage damage was most commonly seen in the patellofemoral joint and medial femoral condyle but was not associated with the development of knee OA based on the Kellgren-Lawrence grade. MRI of the FCDs revealed increased water content, cartilage deterioration, and proteoglycan loss within the medial and lateral compartments.Conclusion:Patients with untreated FCDs of the knee joint are more likely to experience a progression of cartilage damage, although the studies included in this review did not demonstrate the development of radiographically evident OA within 2 years of follow-up.

Gene expression and functional comparison between multipotential stromal cells from lateral and medial condyles of knee osteoarthritis patients

“…1c, medial). Altogether these data were consistent with previous findings indicating much more pronounced osteochondral damage and therefore more severe disease in medial condyles of patients with a varus deformity of the knee 19,21 .

Figure 1Histological assessment of tissue damage in osteoarthritic femoral condyles. ( a ) Example macroscopic (top) and microscopic (bottom) images of safranin-O stained sections illustrating the spectrum on cartilage damage in both medial and lateral condyles.

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“…Human knee OA provides a potentially unique model for the study of MSCs in joint repair, homeostasis and OA progression. This is because the anatomical structure and biomechanical configuration of the knee is typically associated with much more severe cartilage loss on the predominantly weight-bearing medial compartment 4,19–21 . The aim of this study was therefore to investigate and compare the numbers, topography and gene expression profiles of subchondral bone-resident MSCs from medial and lateral femoral condyles from the same patient.…”

Osteoarthritis and ACL Reconstruction—Myths and Risks

“…Cross-sectional studies have demonstrated that regardless of their morphology, meniscus tears can predict the development of knee OA [60,61]. Similarly, in early follow up, focal cartilage lesions have led to progression of knee OA [62]. In the setting of ACL injury, the status of the meniscus and the cartilage play a big role in the development of knee OA.…”

The performance of resurfacing implants for focal cartilage defects depends on the degenerative condition of the opposing cartilage

“…Focal cartilage injuries in the knee joint are a common disorder and often associated with pain and disability (Curl et al, 1997;Årøen et al, 2004;Hjelle et al, 2002;Widuchowski et al, 2007). Because cartilage lacks blood supply, it has only a very limited response to injury and thus focal defects may lead to further damage and osteoarthritis if left untreated (Marchi et al, 2019;Houck et al, 2018;Jungmann et al, 2018). Treatment options depend on factors like defect size, location and age of the patient.…”