Strategies for patient profiling in articular cartilage repair of the knee: a prospective cohort of patients treated by one experienced cartilage surgeon

Abstract

PurposeThe purpose of this study was to report on the clinical outcome of a large heterogenic cartilage repair population treated with the profiling strategies of one experienced cartilage surgeon to provide evidence based tools for treatment selection in a clinical environment.MethodsA total of 216 patients were identified in this prospective single-surgeon study. For the primary and secondary treatment of smaller defects, microfracture (MF) was used. Hyalograft C was used for first and second line larger defects, while carbon-fiber rod and pad implantations were used as a salvage procedure.ResultsThree years after the initial procedure, the clinical improvement was excellent for MF and Hyalograft C (P < 0.001) and good for carbon-fiber procedures (P < 0.05). Hyalograft C patients with prior anterior cruciate ligament reconstruction had less clinical improvement (P < 0.05), while MF patients with prior cartilage repair were more likely to fail (Odds Ratio 20.5, P < 0.05).ConclusionThis is the first study that provides an assessment of the treatment strategies used by an experienced cartilage surgeon. A treatment algorithm for cartilage repair in a heterogenic population was created that based on the findings of this study could be implemented in a clinical environment.Level of evidence Prospective clinical case series, Level IV

Is Magnetic Resonance Imaging Reliable in Predicting Clinical Outcome After Articular Cartilage Repair of the Knee?

“…5,24,26,37,45,55 As such, surgeons mainly rely on expertise when interpreting an MRI scan after cartilage repair. 9 This systematic review sought to evaluate the correlation between MRI and clinical outcome after cartilage repair to elucidate the inconsistency in the literature and to identify parameters that are most important in determining clinical outcome. A systematic search of the MED-LINE, Embase, and Cochrane Collaboration databases resulted in a total of 32 studies after application of inclusion and exclusion criteria.…”

Autologous cartilage fragments in a composite scaffold for one stage osteochondral repair in a goat model

“…The most commonly available treatments to enhance the quality of repair of symptomatic deep cartilage and osteochondral lesions include: 1) bone marrow stimulation (microfractures, MF) (Mithoefer et al, 2005); 2) osteochondral autograft transplantation (OAT) (Bobic, 1999) (Gudas et al, 2012); and 3) autologous chondrocyte implantation (ACI) (Peterson et al, 2010). MF and single-plug OAT are usually implemented for small chondral and osteochondral defects (< 1-2 cm 2 ), while for larger lesions, multiple OAT and ACI are both preferable treatment options (Bekkers et al, 2009;De Windt et al, 2012).…”

Cartilage repair in the degenerative ageing knee

“…In another study (de Windt et al. 2012), carbon fiber implants were used for salvage cases with degenerative joints treated arthroscopically, and there were statistically significant clinical improvements at 3 years after surgery.…”