Current Treatments of Isolated Articular Cartilage Lesions of the Knee Achieve Similar Outcomes

• Published in: Clinical orthopaedics and related research 2012-08, Vol.470 (8), p.2261-2267
• Main Authors: Lim, Hong-Chul, Bae, Ji-Hoon, Song, Sang-Heon, Park, Young-Eun, Kim, Seung-Ju
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Arthroplasty, Subchondral; Arthroscopy; Autografts; Biological and medical sciences; Cartilage (articular); Cartilage, Articular - injuries; Cartilage, Articular - pathology; Cartilage, Articular - surgery; Cell Transplantation; Chondrocytes; Chondrocytes - transplantation; Clinical Research; Conservative Orthopedics; Diseases of the osteoarticular system; Female; Fractures; Fractures, Cartilage - rehabilitation; Fractures, Cartilage - surgery; Functional magnetic resonance imaging; Hospitals; Humans; Injuries; Knee; Knee Injuries; Knee Joint - surgery; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical sciences; Medicine; Medicine & Public Health; Orthopedic Procedures - adverse effects; Orthopedic Procedures - methods; Orthopedics; Outcome Assessment (Health Care); Postoperative Complications; Prospective Studies; Sports Medicine; Surgery; Surgical Orthopedics; Transplantation, Autologous; Transplantation, Homologous; Treatment Outcome; Young Adult
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-012-2304-9

Background 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. Questions/purposes We compared postoperative functional outcomes, followup MRI appearance, and arthroscopic examination after microfracture (MF), osteochondral autograft transplantation (OAT), or autologous chondrocyte implantation (ACI). Methods 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. Results 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. Conclusions 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.