Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 9, pp 2070–2075 | Cite as

Trends in the surgical treatment of articular cartilage defects of the knee in the United States

  • Scott R. MontgomeryEmail author
  • Brock D. Foster
  • Stephanie S. Ngo
  • Rodney D. Terrell
  • Jeffrey C. Wang
  • Frank A. Petrigliano
  • David R. McAllister



The purpose of this study was to evaluate trends in surgical treatment of articular cartilage defects of the knee in the United States.


The current procedural terminology (CPT) billing codes of patients undergoing articular cartilage procedures of the knee were searched using the PearlDiver Patient Record Database, a national database of insurance billing records. The CPT codes for chondroplasty, microfracture, osteochondral autograft, osteochondral allograft, and autologous chondrocyte implantation (ACI) were searched.


A total of 163,448 articular cartilage procedures of the knee were identified over a 6-year period. Microfracture and chondroplasty accounted for over 98 % of cases. There was no significant change in the incidence of cartilage procedures noted from 2004 (1.27 cases per 10,000 patients) to 2009 (1.53 cases per 10,000 patients) (p = 0.06). All procedures were performed more commonly in males (p < 0.001). This gender difference was smallest in patients undergoing chondroplasty (51 % males and 49 % females) and greatest for open osteochondral allograft (61 % males and 39 % females). Chondroplasty and microfracture were most commonly performed in patients aged 40–59, while all other procedures were performed most frequently in patients <40 years old (p < 0.001).


Articular cartilage lesions of the knee are most commonly treated with microfracture or chondroplasty in the United States. Chondroplasty and microfracture were most often performed in middle-aged patients, whereas osteochondral autograft, allograft, and ACI were performed in younger patients, and more frequently in males.

Level of evidence

Cross-sectional study, Level IV.


Knee Articular cartilage Trends Demographics Surgery Arthroscopy 


  1. 1.
    Alford JW, Cole BJ (2005) Cartilage restoration, part 2: techniques, outcomes, and future directions. Am J Sports Med 33:443–460PubMedCrossRefGoogle Scholar
  2. 2.
    Årøen A, Heir S, Løken S, Engebretsen L, Reinholt FP (2006) Healing of articular cartilage defects. An experimental study of vascular and minimal vascular microenvironment. J Orthop Res 24:1069–1077PubMedCrossRefGoogle Scholar
  3. 3.
    Aubin PP, Cheah HK, Davis AM, Gross AE (2001) Long-term followup of fresh femoral osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res 391:S318–S327PubMedCrossRefGoogle Scholar
  4. 4.
    Bederman SS, Rosen CD, Bhatia NN, Kiester PD, Gupta R (2012) Drivers of surgery for the degenerative hip, knee, and spine: a systematic review. Clin Orthop Relat Res 470:1090–1105PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    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 85:223–230PubMedCrossRefGoogle Scholar
  6. 6.
    Cerynik DL, Lewullis GE, Joves BC, Palmer MP, Tom JA (2009) Outcomes of microfracture in professional basketball players. Knee Surg Sports Traumatol Arthrosc 17:1135–1139PubMedCrossRefGoogle Scholar
  7. 7.
    Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13:456–460PubMedCrossRefGoogle Scholar
  8. 8.
    Daffner SD, Beimesch CF, Wang JC (2010) Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis. Spine 35:1165–1169PubMedGoogle Scholar
  9. 9.
    Farr J, Cole B, Dhawan A, Kercher J, Sherman S (2011) Clinical cartilage restoration: evolution and overview. Clin Orthop Relat Res 469:2696–2705PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Gobbi A, Nunag P, Malinowski K (2005) Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc 13:213–221PubMedCrossRefGoogle Scholar
  11. 11.
    Granan LP, Bahr R, Lie SA, Engebretsen L (2009) Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: a cohort study based on the Norwegian National Knee Ligament Registry. Am J Sports Med 37:955–961PubMedCrossRefGoogle Scholar
  12. 12.
    Hubbard MJ (1996) Articular debridement versus washout for degeneration of the medial femoral condyle. A five-year study. J Bone Joint Surg Br 78:217–219PubMedGoogle Scholar
  13. 13.
    Jakobsen RB, Engebretsen L, Slauterbeck JR (2005) An analysis of the quality of cartilage repair studies. J Bone Joint Surg Am 87:2232–2239PubMedCrossRefGoogle Scholar
  14. 14.
    Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ, Feagan BG, Donner A, Griffin SH, D’Ascanio LM, Pope JE, Fowler PJ (2008) A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 359:1097–1107PubMedCrossRefGoogle Scholar
  15. 15.
    Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, Ghanem N, Uhl M, Südkamp N (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22:1180–1186PubMedCrossRefGoogle Scholar
  16. 16.
    Mithoefer K, Williams RJ 3rd, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 87:1911–1920PubMedCrossRefGoogle Scholar
  17. 17.
    Moran CJ, Barry FP, Maher SA, Shannon FJ, Rodeo SA (2012) Advancing regenerative surgery in orthopaedic sports medicine: the critical role of the surgeon. Am J Sports Med 40:934–944PubMedCrossRefGoogle Scholar
  18. 18.
    Musahl V, Jordan SS, Colvin AC, Tranovich MJ, Irrgang JJ, Harner CD (2010) Practice patterns for combined anterior cruciate ligament and meniscal surgery in the United States. Am J Sports Med 38:918–923PubMedCrossRefGoogle Scholar
  19. 19.
    Namdari S, Baldwin K, Anakwenze O, Park MJ, Huffman GR, Sennett BJ (2009) Results and performance after microfracture in National Basketball Association athletes. Am J Sports Med 37:943–948PubMedCrossRefGoogle Scholar
  20. 20.
    Salzmann GM, Niemeyer P, Steinwachs M, Kreuz PC, Südkamp NP, Mayr HO (2011) Cartilage repair approach and treatment characteristics across the knee joint: a European survey. Arch Orthop Trauma Surg 131:283–291PubMedCrossRefGoogle Scholar
  21. 21.
    Schneider U, Rackwitz L, Andereya S, Siebenlist S, Fensky F, Reichert J, Löer I, Barthel T, Rudert M, Nöth U (2011) A prospective multicenter study on the outcome of Type I collagen hydrogel-based autologous chondrocyte implantation (CaReS) for the repair of articular cartilage defects in the knee. Am J Sports Med 39:2558–2565PubMedCrossRefGoogle Scholar
  22. 22.
    Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484PubMedCrossRefGoogle Scholar
  23. 23.
    Versier G, Dubrana F, The French Arthroscopy Society (2011) Treatment of knee cartilage defect in 2010. Orthop Traumatol Surg Res 97:S140–S153PubMedCrossRefGoogle Scholar
  24. 24.
    Zhang AL, Kreulen C, Ngo SS, Hame SL, Wang JC, Gamradt SC (2012) Demographic trends in arthroscopic SLAP repair in the United States. Am J Sports Med 40:1144–1147PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Scott R. Montgomery
    • 1
    Email author
  • Brock D. Foster
    • 1
  • Stephanie S. Ngo
    • 1
  • Rodney D. Terrell
    • 1
  • Jeffrey C. Wang
    • 1
  • Frank A. Petrigliano
    • 1
  • David R. McAllister
    • 1
  1. 1.Department of Orthopaedic SurgeryDavid Geffen School of Medicine at UCLALos AngelesUSA

Personalised recommendations