Skip to main content
SpringerLink
Log in

High degree of consensus amongst an expert panel regarding focal resurfacing of chondral and osteochondral lesions of the femur with mini-implants

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

Abstract

Introduction

The rationale for the use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions is still under debate. The evidence supporting best practise guidelines is based on studies with low-level evidence. A consensus group of experts was convened to collaboratively advance towards consensus opinions regarding the best available evidence. The purpose of this article is to report the resulting consensus statements.

Methods

Twenty-five experts participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted via an online survey of two rounds, for initial agreement and comments on the proposed statements. An in-person meeting between the panellists was organised during the 2022 ESSKA congress to further discuss and debate each of the statements. A final agreement was made via a final online survey a few days later. The strength of consensus was characterised as: consensus, 51–74% agreement; strong consensus, 75–99% agreement; unanimous, 100% agreement.

Results

Statements were developed in the fields of patient assessment and indications, surgical considerations and postoperative care. Between the 25 statements that were discussed by this working group, 18 achieved unanimous, whilst 7 strong consensus.

Conclusion

The consensus statements, derived from experts in the field, represent guidelines to assist clinicians in decision-making for the appropriate use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions.

Level of evidence

Level V.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

Not applicable.

References

  1. Australian Orthopaedic Association National Joint Replacement Registry 2021

  2. National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. 17th Annual Report 2020

  3. NICE (National Institute for Health and Care Excellence) (2022) Focal resurfacing implants to treat articular cartilage damage in the knee. Accessed Apr 17 2023

  4. Al-Bayati M, Martinez-Carranza N, Roberts D, Hogstrom M, Stalman A (2022) Good subjective outcome and low risk of revision surgery with a novel customized metal implant for focal femoral chondral lesions at a follow-up after a minimum of 5 years. Arch Orthop Trauma Surg 142:2887–2892

    Article  PubMed  Google Scholar 

  5. Becher C, Cantiller EB (2017) Focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee: 12-year follow-up of two cases and review of the literature. Arch Orthop Trauma Surg 137:1307–1317

    Article  CAS  PubMed  Google Scholar 

  6. Becher C, Kalbe C, Thermann H, Paessler HH, Laprell H, Kaiser T et al (2011) Minimum 5-year results of focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee. Arch Orthop Trauma Surg 131:1135–1143

    Article  PubMed  Google Scholar 

  7. Brittberg M, Gomoll AH, Canseco JA, Far J, Lind M, Hui J (2016) Cartilage repair in the degenerative ageing knee. Acta Orthop 87:26–38

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cases E, Natera L, Anton C, Consigliere P, Guillen J, Cruz E et al (2021) Focal inlay resurfacing for full-thickness chondral defects of the femoral medial condyle may delay the progression to varus deformity. Eur J Orthop Surg Traumatol 31:57–63

    Article  PubMed  Google Scholar 

  9. Cepni S, Veizi E, Tahta M, Uluyardimci E, Abughalwa MJT, Isik C (2020) Focal metallic inlay resurfacing prosthesis in articular cartilage defects: short-term results of 118 patients and 2 different implants. Arch Orthop Trauma Surg 140:209–218

    Article  PubMed  Google Scholar 

  10. Christensen BB, El-Galaly A, Laursen JO, Lind M (2021) Eighty percent survival of resurfacing implants in the knee after 10 years: a nationwide cohort study on 379 procedures from the Danish knee arthroplasty registry. Cartilage 13:900S-906S

    Article  PubMed  PubMed Central  Google Scholar 

  11. Christensen JC, Brothers J, Stoddard GJ, Anderson MB, Pelt CE, Gililland JM et al (2017) Higher frequency of reoperation with a new bicruciate-retaining total knee arthroplasty. Clin Orthop Relat Res 475:62–69

    Article  PubMed  Google Scholar 

  12. Crawford DA, Adams JB, Hobbs GR, Berend KR, Lombardi AV Jr (2020) Higher activity level following total knee arthroplasty is not deleterious to mid-term implant survivorship. J Arthroplasty 35:116–120

    Article  PubMed  Google Scholar 

  13. Crawford DA, Adams JB, Lombardi AV Jr, Berend KR (2019) Activity level does not affect survivorship of unicondylar knee arthroplasty at 5-year minimum follow-up. J Arthroplasty 34:1364–1368

    Article  PubMed  Google Scholar 

  14. Elbardesy H, Nagle M, Simmons L, Harty J (2021) The partial femoral condyle focal resurfacing (HemiCAP-UniCAP) for treatment of full-thickness cartilage defects, systematic review and meta-analysis. Acta Orthop Belg 87:93–102

    Article  PubMed  Google Scholar 

  15. Fuchs A, Eberbach H, Izadpanah K, Bode G, Sudkamp NP, Feucht MJ (2018) Focal metallic inlay resurfacing prosthesis for the treatment of localized cartilage defects of the femoral condyles: a systematic review of clinical studies. Knee Surg Sports Traumatol Arthrosc 26:2722–2732

    Article  PubMed  Google Scholar 

  16. Greco NJ, Lombardi AV Jr, Price AJ, Berend ME, Berend KR (2018) Medial mobile-bearing unicompartmental knee arthroplasty in young patients aged less than or equal to 50 years. J Arthroplasty 33:2435–2439

    Article  PubMed  Google Scholar 

  17. Holz J, Spalding T, Boutefnouchet T, Emans P, Eriksson K, Brittberg M et al (2021) Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years. Knee Surg Sports Traumatol Arthrosc 29:2899–2910

    Article  PubMed  Google Scholar 

  18. Laursen JO, Backer Mogensen C, Skjot-Arkil H (2021) HemiCAP knee implants: mid- to long-term results. Cartilage 13:1718S-1725S

    Article  PubMed  Google Scholar 

  19. Laursen JO, Lind M, Mogensen CB, Skjot-Arkil H (2020) A longterm prospective follow-up study of resurfacing miniprosthesis suitable for patients above sixty five years with localized cartilage lesions or early osteoarthritis in the knee. J Exp Orthop 7:96

    Article  PubMed  PubMed Central  Google Scholar 

  20. Laursen JO, Mogensen CB, Skjot-Arkil H (2019) UniCAP offers a long term treatment for middle-aged patients, who are not revised within the first 9 years. Knee Surg Sports Traumatol Arthrosc 27:1693–1697

    Article  PubMed  Google Scholar 

  21. Malahias MA, Chytas D, Thorey F (2018) The clinical outcome of the different HemiCAP and UniCAP knee implants: a systematic and comprehensive review. Orthop Rev (Pavia) 10:7531

    Article  PubMed  Google Scholar 

  22. Megaloikonomos PD, Becher C, Van der Stok J, O’Donnell T (2023) Femoral condyle resurfacing using an inlay metal implant: low revision rate of 266 patients in a 5–10 years follow-up. Arch Orthop Trauma Surg 143:1243–1251

    Article  PubMed  Google Scholar 

  23. Nahas S, Monem M, Li L, Patel A, Parmar H (2020) Ten-year average full follow-up and evaluation of a contoured focal resurface prosthesis (HemiCAP) in patients in the United Kingdom. J Knee Surg 33:966–970

    Article  PubMed  Google Scholar 

  24. Nathwani D, McNicholas M, Hart A, Miles J, Bobic V (2017) Partial resurfacing of the Knee with the BioPoly implant: interim report at 2 years. JB JS Open Access 2:e0011

    Article  PubMed  PubMed Central  Google Scholar 

  25. Pennington DW, Swienckowski JJ, Lutes WB, Drake GN (2003) Unicompartmental knee arthroplasty in patients sixty years of age or younger. J Bone Jt Surg Am 85:1968–1973

    Article  Google Scholar 

  26. Price AJ, Dodd CA, Svard UG, Murray DW (2005) Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age. J Bone Jt Surg Br 87:1488–1492

    Article  CAS  Google Scholar 

  27. Robinson PG, Williamson T, Murray IR, Al-Hourani K, White TO (2020) Sporting participation following the operative management of chondral defects of the knee at mid-term follow up: a systematic review and meta-analysis. J Exp Orthop 7:76

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Springer B, Boettner F (2021) Treatment of unicompartmental cartilage defects of the knee with unicompartmental knee arthroplasty, patellofemoral partial knee arthroplasty or focal resurfacing. Life (Basel) 11(5):394

    PubMed  Google Scholar 

  29. van Buul GM, Stanclik J, van der Stok J, Queally JM, O’Donnell T (2021) Focal articular surface replacement of knee lesions after failed cartilage repair using focal metallic implants: a series of 132 cases with 4-year follow-up. Knee 29:134–141

    Article  PubMed  Google Scholar 

  30. W-Dahl A, Robertsson O, Lidgren L, Miller L, Davidson D, Graves S (2010) Unicompartmental knee arthroplasty in patients aged less than 65. Acta Orthop 81:90–94

    Article  PubMed  PubMed Central  Google Scholar 

  31. Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Jt Surg Am 85:1–3

    Article  Google Scholar 

Download references

Funding

No funding was received to assist with the preparation of this manuscript.

Author information

Author notes

  1. Christoph Becher and Panayiotis D. Megaloikonomos have contributed equally to this paper and share first authorship.

Authors and Affiliations

  1. International Centre for Orthopedics, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany

    Christoph Becher & Panayiotis D. Megaloikonomos

  2. Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark

    Martin Lind

  3. Department of Orthopaedic Surgery, Stockholm South Hospital, Department of Clinical Science and Education Karolinska Institutet, Stockholm, Sweden

    Karl Eriksson

  4. Cartilage Research Unit, Region Halland Orthopaedics, Varberg Hospital, University of Gothenburg, Varberg, Sweden

    Mats Brittberg

  5. Department of Orthopaedics and Traumatology, Barmherzige Brüder Hospital, Munich, Germany

    Johannes Beckmann

  6. Orthoca, AZ Monica, Antwerp, Belgium

    Peter Verdonk

  7. Department of Surgical and Perioperative Sciences, Sports Medicine Umeå and Orthopedics, Umeå University, Umeå, Sweden

    Magnus Högström

  8. Department of Orthopedic Surgery, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark

    Lars Konradsen

  9. OrthoCentrum Hamburg, Hamburg, Germany

    Johannes Holz

  10. Hospital for Orthopedic Surgery and Sports Medicine, Siegen, Germany

    Alois Franz

  11. Orthopaedic Clinic Paulinenhilfe, Diakonie-Hospital, Stuttgart, Germany

    Matthias J. Feucht

  12. Department of Traumatology and Orthopedics, Maria-Josef-Hospital Greven, Greven, Germany

    Clemens Kösters

  13. Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, The Netherlands

    Gerben van Buul

  14. Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institute, Stockholm, Sweden

    Olof Sköldenberg

  15. Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

    Pieter J. Emans

  16. University Hospitals Birmingham NHS Trust, Mindelsohn Way, Edgbaston, Birmingham, UK

    Tarek Boutefnouchet

  17. Imperial College NHS Trust London, London, UK

    Dinesh Nathwani

  18. Liverpool University Hospitals NHS FT, Liverpool, UK

    Mike J. McNicholas

  19. Department of Orthopedics, Beacon Hospital, Sandyford, Dublin, Ireland

    Turlough O’Donnell

  20. Cleveland Clinic London, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK

    Tim Spalding

  21. Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden

    Anders Stålman

  22. MVZ Gelenk-Klinik, Gundelfingen, Germany

    Sven Ostermeier

  23. Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany

    Andreas B. Imhoff

  24. Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

    Alexander D. Shearman

  25. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland

    Michael Hirschmann

Authors
  1. Christoph Becher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Panayiotis D. Megaloikonomos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Lind
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karl Eriksson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mats Brittberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Johannes Beckmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter Verdonk
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Magnus Högström
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lars Konradsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Johannes Holz
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alois Franz
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Matthias J. Feucht
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Clemens Kösters
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Gerben van Buul
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Olof Sköldenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Pieter J. Emans
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Tarek Boutefnouchet
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Dinesh Nathwani
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Mike J. McNicholas
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Turlough O’Donnell
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Tim Spalding
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Anders Stålman
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Sven Ostermeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Andreas B. Imhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Alexander D. Shearman
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Michael Hirschmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph Becher.

Ethics declarations

Conflict of interest

Karl Eriksson, Clemens Kösters, Mats Brittberg, Johannes Holz, Tim Spalding and Peter Verdonk are members of the Consultant Advisory Board for Episurf AB, Stockholm, Sweden. Mike J. McNicholas was a paid consultant for BioPoly, Fort Wayne, IN, USA. Anders Stålman received research funding from Episurf AB, Stockholm, Sweden. Pieter J. Emans served as a speaker for Episurf AB, Stockholm, Sweden. Christoph Becher received research funding from Arthrosurface Inc, Franklin, MA, USA. Andreas B. Imhoff was a paid consultant for Arthrosurface Inc, Franklin, MA, USA. There are no other conflicts.

Ethical approval

This work is exempt from institutional board approval.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Becher, C., Megaloikonomos, P.D., Lind, M. et al. High degree of consensus amongst an expert panel regarding focal resurfacing of chondral and osteochondral lesions of the femur with mini-implants. Knee Surg Sports Traumatol Arthrosc 31, 4027–4034 (2023). https://doi.org/10.1007/s00167-023-07450-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-023-07450-8

Keywords

Search

Navigation