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Cartilage repair surgery prevents progression of knee degeneration

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate, whether cartilage repair surgery for focal osteochondral defects at the knee results in less degenerative changes over 6 years in a MR imaging follow-up than morphologically initially identical defects in non-operated control subjects from the osteoarthritis initiative (OAI).

Methods

A total of 32 individuals received baseline and follow-up MRI. In n = 16 patients with cartilage repair [osteochondral autograft transfer system (OATS), n = 12; spongiosa-augmented matrix-associated autologous chondrocyte implantation (MACI), n = 4] MRI was performed preoperatively and after 5.7 ± 2.3 year follow-up. Baseline MRIs of non-operated subjects from the OAI were screened for initially identical cartilage defects (n = 16). Morphological knee abnormalities were assessed using WORMS, AMADEUS and MOCART scores. A sagittal 2D MSME sequence was implemented for quantitative cartilage T2 relaxation time measurements in all (0, 2, 4, 6 and 8-years) follow-ups from the OAI and in the postoperative MRI protocol.

Results

For both groups, focal osteochondral defects were located at the femoral condyle in 8/16 cases (5 medial, 3 lateral) and at the patella in 8/16 cases. At baseline, the mean cartilage defect size ± SD was 1.4 ± 1.3 cm2 for the control group and 1.3 ± 1.2 cm2 for the cartilage repair group (n.s.). WORMS scores were not significantly different between the cartilage repair group and the control group at baseline [mean difference ± SEM (95%CI); 0.5 ± 2.5 (− 4.7, 5.7), n.s.]. During identical follow-up times, the progression of total WORMS scores [19.9 ± 2.3 (15.0, 24.9), P < 0.001] and of cartilage defects scores in the affected (P < 0.001) and in the opposing (P = 0.029) compartment was significantly more severe in non-operated individuals (P < 0.05). In non-operated subjects, T2 values increased continuously from baseline to the 8-year follow-up (P = 0.001).

Conclusions

Patients with cartilage repair showed less progression of degenerative MRI changes at 6-year follow-up than a control cohort from the OAI with initially identical osteochondral defects. Patients with focal cartilage defects may profit from cartilage repair surgery since it may prevent progression of early osteoarthritis at the knee joint.

Level of evidence

Prognostic study, Level II.

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Funding

The study was funded by the B. Braun Stiftung (BBST-D-17-00070R1). The study was supported by the Osteoarthritis Initiative, a public–private partnership comprising 5 NIH contracts (National Institute of Arthritis and Musculoskeletal and Skin Diseases contracts N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262), with research conducted by the Osteoarthritis Initiative Study Investigators. The study was also funded in part by the Intramural Research Program of the National Institute on Aging, NIH. Private funding partners include Merck Research, Novartis Pharmaceuticals, GlaxoSmithKline, and Pfizer; the private sector funding for the Osteoarthritis Initiative is managed by the Foundation for the National Institutes of Health.

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Authors and Affiliations

  1. Department of Neuroradiology, University Hospital of Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland

    Pia M. Jungmann

  2. Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany

    Pia M. Jungmann, Alexandra S. Gersing & Ernst J. Rummeny

  3. Clinical and Interventional Angiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Frederic Baumann

  4. Department of Sportsorthopedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany

    Christian Holwein, Sepp Braun & Andreas B. Imhoff

  5. BG Unfallklinik Murnau, Prof.-Küntscher-Strasse 8, 82418, Murnau, Germany

    Christian Holwein

  6. Gelenkpunkt, Sports and Joint Surgery Innsbruck, Olympiastrasse 39, 6020, Innsbruck, Austria

    Sepp Braun

  7. Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA

    Jan Neumann, Julia Zarnowski, Felix C. Hofmann & Thomas M. Link

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  1. Pia M. Jungmann
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  2. Alexandra S. Gersing
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  3. Frederic Baumann
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  4. Christian Holwein
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Contributions

All authors (PMJ, ASG, FB, CH, SB, JN, JZ, FCH, ABI, EJR, TML) have made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data. All authors (PMJ, ASG, FB, CH, SB, JN, JZ, FCH, ABI, EJR, TML) have been involved in drafting the manuscript or revising it critically for important intellectual content. All authors (PMJ, ASG, FB, CH, SB, JN, JZ, FCH, ABI, EJR, TML) have given final approval of the version to be published. All authors (PMJ, ASG, FB, CH, SB, JN, JZ, FCH, ABI, EJR, TML) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors have participated sufficiently in the work to take public responsibility for appropriate portions of the content.

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Correspondence to Pia M. Jungmann.

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Conflict of interest

No conflict of interest for any of the authors.

Ethical approval

The study was approved by the local Institutional Review Boards (Ethikkommission Technical University of Munich). The OAI study protocol, amendments, and informed consent documentation including analysis plans were reviewed and approved by the local institutional review boards. Data used in the preparation of this manuscript were obtained from the OAI database, which is available for public access at http://www.oai.ucsf.edu/. The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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All subjects gave written informed consent prior to participation in the study.

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Jungmann, P.M., Gersing, A.S., Baumann, F. et al. Cartilage repair surgery prevents progression of knee degeneration. Knee Surg Sports Traumatol Arthrosc 27, 3001–3013 (2019). https://doi.org/10.1007/s00167-018-5321-8

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