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

Abstract

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.

Previous cartilage surgery is associated with inferior patient‐reported outcomes after knee arthroplasty

“…There could have been a discrepancy in the preoperative KOOS scores between the groups. However, several studies have demonstrated PREVIOUS CARTILAGE SURGERY AFTER KNEE ARTHROPLASTY | 367 that cartilage patients have similar KOOS QoL subscores to patients awaiting knee arthroplasty [2,3], indicating that the preoperative PROM in the cartilage cohort might be comparable to those in the control group.…”

“…Focal cartilage lesions (FCLs) in the knee exhibit poor natural healing capabilities [1] and may significantly reduce quality of life (QoL) [2,3]. Even in surgically treated FCLs, normal knee function is often not achieved [4].…”

Effects of alendronate on cartilage lesions and micro-architecture deterioration of subchondral bone in patellofemoral osteoarthritic ovariectomized rats with patella-baja

“…The occurrence and development of OA is usually accompanied by cartilage injury and abnormal changes of subchondral bone. In the investigation of human OA, partial or full-layer defects of articular cartilage were found in patellofemoral joints during surgery and autopsy [ 30 , 31 ]. Compared with femoral trochlear cartilage, the fibrosis, longitudinal fissure and softening swelling of human patella cartilage in the early stage are more obvious and serious [ 32 ].…”

Management of Articular Cartilage Defects in the Knee: An Evidence-Based Algorithm

“…Lesions are typically defined by defect size and severity, with common size cutoffs cited in the literature (small, <2 cm 2 ; medium, 2 cm 2 to 5 cm 2 ; and large, >5 cm 2 ) 17 . There are several intraoperative classification systems to grade severity of chondral defects, including the Outerbridge arthroscopic system and the International Cartilage Repair Society (ICRS) classification system 18,19 .…”