Current Treatments of Isolated Articular Cartilage Lesions of the Knee Achieve Similar Outcomes
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Many surgical techniques, including microfracture, periosteal and perichondral grafts, chondrocyte transplantation, and osteochondral grafts, have been studied in an attempt to restore damaged articular cartilage. However, there is no consensus regarding the best method to repair isolated articular cartilage defects of the knee.
We compared postoperative functional outcomes, followup MRI appearance, and arthroscopic examination after microfracture (MF), osteochondral autograft transplantation (OAT), or autologous chondrocyte implantation (ACI).
We prospectively investigated 30 knees with MF, 22 with OAT, and 18 with ACI. Minimum followup was 3 years (mean, 5 years; range, 3–10 years). We included only patients with isolated cartilage defects and without other knee injuries. The three procedures were compared in terms of function using the Lysholm knee evaluation scale, Tegner activity scale, and Hospital for Special Surgery (HSS) score; modified Outerbridge cartilage grades using MRI; and International Cartilage Repair Society (ICRS) repair grade using arthroscopy.
All three procedures showed improvement in functional scores. There were no differences in functional scores and postoperative MRI grades among the groups. Arthroscopy at 1 year showed excellent or good results in 80% after MF, 82% after OAT, and 80% after ACI. Our study did not show a clear benefit of either ACI or OAT over MF.
Owing to a lack of superiority of any one treatment, we believe MF is a reasonable option as a first-line therapy given its ease and affordability relative to ACI or OAT.
Level of Evidence
Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Alparslan, L, Winalski, CS, Boutin, RD, Minas, T (2001) Postoperative magnetic resonance imaging of articular cartilage repair. Semin Musculoskelet Radiol. 5: pp. 345-363 CrossRef
- Anderson, AF, Richards, DB, Pagnani, MJ, Hovis, WD (1997) Antegrade drilling for osteochondritis dissecans of the knee. Arthroscopy. 13: pp. 319-324 CrossRef
- Bentley, G, Biant, LC, Carrington, RW, Akmal, M, Goldberg, A, Williams, AM, Skinner, JA, Pringle, J (2003) A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. 85: pp. 223-230 CrossRef
- Brittberg, M, Winalski, CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am. 85: pp. 58-69
- Duchow, J, Hess, T, Kohn, D (2000) Primary stability of press-fit-implanted osteochondral grafts: influence of graft size, repeated insertion, and harvesting technique. Am J Sports Med. 28: pp. 24-27
- Frisbie, DD, Oxford, JT, Southwood, L, Trotter, GW, Rodkey, WG, Steadman, JR, Goodnight, JL, McIlwraith, CW (2003) Early events in cartilage repair after subchondral bone microfracture. Clin Orthop Relat Res. 407: pp. 215-227 CrossRef
- Gudas, R, Simonaityte, R, Cekanauskas, E, Tamosiunas, R (2009) A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children. J Pediatr Orthop. 29: pp. 741-748 CrossRef
- Gudas, R, Stankevicius, E, Monastyreckiene, E, Pranys, D, Kalesinskas, RJ (2006) Osteochondral autologous transplantation versus microfracture for the treatment of articular cartilage defects in the knee joint in athletes. Knee Surg Sports Traumatol Arthrosc. 14: pp. 834-842 CrossRef
- Hangody, L, Fules, P (2003) Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am. 85: pp. 25-32
- Hangody, L, Rathonyi, GK, Duska, Z, Vasarhelyi, G, Fules, P, Modis, L (2004) Autologous osteochondral mosaicplasty: surgical technique. J Bone Joint Surg Am. 86: pp. 65-72
- Hangody, L, Vasarhelyi, G, Hangody, LR, Sukosd, Z, Tibay, G, Bartha, L, Bodo, G (2008) Autologous osteochondral grafting: technique and long-term results. Injury. 39: pp. S32-S39 CrossRef
- Horas, U, Pelinkovic, D, Herr, G, Aigner, T, Schnettler, R (2003) Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint: a prospective, comparative trial. J Bone Joint Surg Am. 85: pp. 185-192
- Insall, JN, Ranawat, CS, Aglietti, P, Shine, J (1976) A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am. 58: pp. 754-765
- Knutsen, G, Engebretsen, L, Ludvigsen, TC, Drogset, JO, Grontvedt, T, Solheim, E, Strand, T, Roberts, S, Isaksen, V, Johansen, O (2004) Autologous chondrocyte implantation compared with microfracture in the knee: a randomized trial. J Bone Joint Surg Am. 86: pp. 455-464
- Krishnan, SP, Skinner, JA, Bartlett, W, Carrington, RW, Flanagan, AM, Briggs, TW, Bentley, G (2006) Who is the ideal candidate for autologous chondrocyte implantation?. J Bone Joint Surg Br. 88: pp. 61-64 CrossRef
- Lysholm, J, Gillquist, J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 10: pp. 150-154 CrossRef
- Marcacci, M, Zaffagnini, S, Kon, E, Visani, A, Iacono, F, Loreti, I (2002) Arthroscopic autologous chondrocyte transplantation: technical note. Knee Surg Sports Traumatol Arthrosc. 10: pp. 154-159 CrossRef
- Micheli, LJ, Browne, JE, Erggelet, C, Fu, F, Mandelbaum, B, Moseley, JB, Zurakowski, D (2001) Autologous chondrocyte implantation of the knee: multicenter experience and minimum 3-year follow-up. Clin J Sport Med. 11: pp. 223-228 CrossRef
- Minas, T (2001) Autologous chondrocyte implantation for focal chondral defects of the knee. Clin Orthop Relat Res. 391: pp. S349-S361 CrossRef
- Outerbridge, RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br. 43: pp. 752-757
- Pelttari, K, Lorenz, H, Boeuf, S, Templin, MF, Bischel, O, Goetzke, K, Hsu, HY, Steck, E, Richter, W (2008) Secretion of matrix metalloproteinase 3 by expanded articular chondrocytes as a predictor of ectopic cartilage formation capacity in vivo. Arthritis Rheum. 58: pp. 467-474 CrossRef
- Peterson, L, Minas, T, Brittberg, M, Nilsson, A, Sjogren-Jansson, E, Lindahl, A (2000) Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res. 374: pp. 212-234 CrossRef
- Potter, HG, Linklater, JM, Allen, AA, Hannafin, JA, Haas, SB (1998) Magnetic resonance imaging of articular cartilage in the knee: an evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am. 80: pp. 1276-1284
- Recht, MP, Goodwin, DW, Winalski, CS, White, LM (2005) MRI of articular cartilage: revisiting current status and future directions. AJR Am J Roentgenol. 185: pp. 899-914 CrossRef
- Roberts, S, McCall, IW, Darby, AJ, Menage, J, Evans, H, Harrison, PE, Richardson, JB (2003) Autologous chondrocyte implantation for cartilage repair: monitoring its success by magnetic resonance imaging and histology. Arthritis Res Ther. 5: pp. R60-R73 CrossRef
- Steadman, JR, Rodkey, WG, Briggs, KK, Rodrigo, JJ (1999) The microfracture technic in the management of complete cartilage defects in the knee joint][in German. Orthopade. 28: pp. 26-32
- Suh, JS, Lee, SH, Jeong, EK, Kim, DJ (2001) Magnetic resonance imaging of articular cartilage. Eur Radiol. 11: pp. 2015-2025 CrossRef
- Tegner, Y, Lysholm, J, Lysholm, M, Gillquist, J (1986) A performance test to monitor rehabilitation and evaluate anterior cruciate ligament injuries. Am J Sports Med. 14: pp. 156-159 CrossRef
- Borne, MP, Raijmakers, NJ, Vanlauwe, J, Victor, J, Jong, SN, Bellemans, J (2007) International Cartilage Repair Society. International Cartilage Repair Society (ICRS) and Oswestry macroscopic cartilage evaluation scores validated for use in Autologous Chondrocyte Implantation (ACI) and microfracture. Osteoarthritis Cartilage. 15: pp. 1397-1402 CrossRef
- Current Treatments of Isolated Articular Cartilage Lesions of the Knee Achieve Similar Outcomes
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