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Changing trends in the use of cartilage restoration techniques for the patellofemoral joint: a systematic review

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The patellofemoral (PF) joint contains the thickest articular cartilage in the human body. Chondral lesions to this area are often misdiagnosed and can predispose to secondary osteoarthritis if left untreated. Treatment options range from arthroscopic debridement to cartilage restoration techniques such as microfracture (MFx), autologous chondrocyte implantation (ACI), and osteochondral autograft transplantation. The purpose of this study was to systematically assess the trends in surgical techniques, outcomes, and complications of cartilage restoration of the PF joint.

Methods

This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The electronic databases PubMed, MEDLINE, and EMBASE were searched from January 1, 2007 to April 30, 2018. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. A two-proportion z test was used to determine whether the differences between the proportions of cartilage restoration techniques used from 2007 to 2012 and 2013–2018 were statistically significant.

Results

Overall, 28 studies were identified, including 708 patients (824 knees) with a mean age of 39.5 ± 10.5 years and a mean follow-up of 39.1 ± 16.0 months. Majority of patients were treated with ACI (45.5%) and MFx (29.6%). A significant increase in the use of the third generation ACI occurred with a simultaneous decreased usage of the conventional MFx over the last 5 years (p < 0.001). All techniques had significant (p < 0.05) improvements in clinical outcomes. The overall complication rate was 9.2%, of which graft hypertrophy (2.7%) was the most prevalent.

Conclusions

ACI was the most common restoration technique. The use of third generation ACI has increased with a concurrent decline in the use of conventional MFx over the latter half of the past decade (p < 0.001). Overall, the various cartilage restoration techniques reported improvements in patient reported outcomes with low complication rates. Definitive conclusions on the optimal treatment remain elusive due to a lack of high-quality comparative studies.

Level of evidence

Level IV, Systematic Review of Level-II–IV studies.

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Funding

No funding was received for the implementation of this study.

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Authors and Affiliations

  1. Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Ajaykumar Shanmugaraj & Gabriel N. Kuper

  2. Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada

    Ryan P. Coughlin, Seper Ekhtiari, Nicole Simunovic & Olufemi R. Ayeni

  3. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Olufemi R. Ayeni

  4. UPMC Center for Sports Medicine, 3200 S. Water St, Pittsburgh, PA, 15203, USA

    Volker Musahl

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  1. Ajaykumar Shanmugaraj
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Contributions

All authors contributed substantially to conception and design, or acquisition of data, or analysis and interpretation of data; drafted the article or revised it critically for important intellectual content; provided the final approval of the version to be published; and agreed to act as guarantor of the work (ensuring that questions related to any part of the work are appropriately investigated and resolved).

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Correspondence to Olufemi R. Ayeni.

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Conflict of interest

ORA is a paid consultant for ConMed. VM is an education consultant for Smith & Nephew. The authors have no other potential conflicts of interests to declare.

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This review did not involve primary data collection from patients.

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Shanmugaraj, A., Coughlin, R.P., Kuper, G.N. et al. Changing trends in the use of cartilage restoration techniques for the patellofemoral joint: a systematic review. Knee Surg Sports Traumatol Arthrosc 27, 854–867 (2019). https://doi.org/10.1007/s00167-018-5139-4

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