Articular Cartilage Lesions in 993 Consecutive Knee Arthroscopies

Årøen, Asbjørn; Løken, Sverre; Heir, Stig; E, Alvik; Ekeland, Arne; Granlund, Odd G.; Engebretsen, Lars

doi:10.1177/0363546503259345

Cited by 508 publications

(220 citation statements)

References 16 publications

(15 reference statements)

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“…The specific aims were to evaluate the feasibility of the program as determined by (1) adherence to the rehabilitation program, (2) clinical changes in knee function, (3) progression of the rehabilitation program, and (4) the occurrence of adverse events.…”

Section: T T Conclusionmentioning

confidence: 99%

The Feasibility of a 3-Month Active Rehabilitation Program for Patients With Knee Full-Thickness Articular Cartilage Lesions: The Oslo Cartilage Active Rehabilitation and Education Study

Wondrasch¹,

Årøen²,

Røtterud³

et al. 2013

Journal of Orthopaedic & Sports Physical Therapy

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Study Design Case series. Objectives To evaluate the feasibility of an active rehabilitation program for patients with knee full-thickness articular cartilage lesions. Background No studies have yet evaluated the effect of active rehabilitation in patients with knee full-thickness articular cartilage lesions or compared the effects of active rehabilitation to those of surgical interventions. As an initial step, the feasibility of such a program needs to be described. Methods Forty-eight patients with a knee full-thickness articular cartilage lesion and a Lysholm score below 75 participated in a 3-month active rehabilitation program consisting of cardiovascular training, knee and hip progressive resistance training, and neuromuscular training. Feasibility was determined by monitoring adherence to the program, clinical changes in knee function, load progression, and adverse events. Patients were tested before and after completing the rehabilitation program by using patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee Subjective Knee Evaluation Form 2000) and isokinetic muscle strength and hop tests. To monitor adherence, load progression, and adverse events, patients responded to an online survey and kept training diaries. Results The average adherence rate to the rehabilitation program was 83%. Four patients (9%) showed adverse events, as they could not perform the exercises due to pain and effusion. Significant and clinically meaningful improvement was found, based on changes on the International Knee Documentation Committee Subjective Knee Evaluation Form 2000, the Knee injury and Osteoarthritis Outcome Score quality of life subscale, isokinetic muscle strength, and hop performance (P<.05), with small to large effect sizes (standardized response mean, 0.3–1.22). Conclusion The combination of a high adherence rate, clinically meaningful changes, and positive load progression and the occurrence of only a few adverse events support the potential usefulness of this program for patients with knee full-thickness cartilage lesions. This study was registered with the public trial registry Clinical Trials.gov (NCT00885729). Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2013;43(5):310–324. Epub 13 March 2013. doi:10.2519/jospt.2013.4354

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Section: T T Conclusionmentioning

confidence: 99%

The Feasibility of a 3-Month Active Rehabilitation Program for Patients With Knee Full-Thickness Articular Cartilage Lesions: The Oslo Cartilage Active Rehabilitation and Education Study

Wondrasch¹,

Årøen²,

Røtterud³

et al. 2013

Journal of Orthopaedic & Sports Physical Therapy

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“…However, several studies report cartilaginous lesions occurring preferentially in the medial compartment and/or in the medial femoral condyle. 1,12,28,31,[37][38][39][40] To recognize age-specific differences, patients were divided into two age subgroups: (A) subjects aged 18-50 years and (B) subjects aged 51-81 years. The majority of grade I lesions occurred in Group A (65%).…”

Section: Discussionmentioning

confidence: 99%

Mapping tibiofemoral gonarthrosis: an MRI analysis of non-traumatic knee cartilage defects

Evangelopoulos

Huesler

Ahmad

et al. 2015

BJR

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Objective: Arthroscopy is "the gold standard" for the diagnosis of knee cartilage lesions. However, it is invasive and expensive, and displays all the potential complications of an open surgical procedure. Ultra-high-field MRI now offers good opportunities for the indirect assessment of the integrity and structural changes of joint cartilage of the knee. The goal of the present study is to determine the site of early cartilaginous lesions in adults with non-traumatic knee pain. Methods: 3-T MRI examinations of 200 asymptomatic knees with standard and three-dimensional doubleecho steady-state (3D-DESS) cartilage-specific sequences were prospectively studied for early degenerative lesions of the tibiofemoral joint. Lesions were classified and mapped using the modified Outerbridge and modified International Cartilage Repair Society classifications.Results: A total of 1437 lesions were detected: 56.1% grade I, 33.5% grade II, 7.2% grade III and 3.3% grade IV. Cartographically, grade I lesions were most common in the anteromedial tibial areas; grade II lesions in the anteromedial L5 femoral areas; and grade III in the centromedial M2 femoral areas. Conclusion: 3-T MRI with standard and 3D-DESS cartilagespecific sequences demonstrated that areas predisposed to early osteoarthritis are the central, lateral and ventromedial tibial plateau, as well as the central and medial femoral condyle. Advances in knowledge: In contrast with previous studies reporting early cartilaginous lesions in the medial tibial compartment and/or in the medial femoral condyle, this study demonstrates that, regardless of grade, lesions preferentially occur at the L5 and M4 tibial and L5 and L2 femoral areas of the knee joint.

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“…The accelerated group covered a significantly greater distance during the 6-minute walk test compared to the traditional group. Robertson et al 59 reported significant improvement over time (3,6,12, and 24 months) in distance covered during the walk test in 31 patients following ACI (age range, 19-60 years). Similar findings were recently reported by Ebert and colleagues 13 in 20 patients (age range, 15-65 years) following ACI and a 12-week rehabilitation program that focused on progressive weight bearing, progressive strengthening activities, and progressive neuromuscular control activities.…”

Section: Outcomes Related To Performancebased Measures Of Functionmentioning

confidence: 99%

“…7,31 In 2 large-scale studies of more than 25 000 knee arthroscopies, 60% of the operated knees demonstrated articular cartilage lesions. 11,74 Approximately 5% to 27% of patients younger than 45 years of age have articular cartilage lesions identified at arthroscopy, 3,11,31,74 and active individuals may be at even higher risk for articular cartilage injury than the general population. 22 In the short term, these lesions may lead to a loss of function and a significant decline in activity participation.…”

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confidence: 99%

Functional Outcomes After Surgical Management of Articular Cartilage Lesions in the Knee: A Systematic Literature Review to Guide Postoperative Rehabilitation

Schmitt¹,

Quatman²,

Paterno³

et al. 2014

J Orthop Sports Phys Ther

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A rticular cartilage injuries are relatively common in the knee and pose a significant problem due to the poor healing potential and long-term disability associated with these lesions. 7,31 In 2 large-scale studies of more than 25 000 knee arthroscopies, 60% of the operated knees demonstrated articular cartilage lesions. 11,74 Approximately 5% to 27% of patients younger than 45 years of age have articular cartilage lesions identified at arthroscopy, 3,11,31,74 and active individuals may be at even higher risk for articular cartilage injury than the general population. 22 In the short term, these lesions may lead to a loss of function and a significant decline in activity participation. 22,25 Although the T T STUDY DESIGN: Systematic literature review. T T OBJECTIVE:To systematically review the literature relative to muscle performance, knee joint biomechanics, and performance-based functional outcomes following articular cartilage repair and restoration surgical procedures in the knee. T T BACKGROUND:Articular cartilage injuries are associated with functional limitations, poor quality of life, and the potential for long-term disability. This review systematically evaluates evidence related to muscle performance, joint biomechanics, and performance-based functional outcomes following articular cartilage procedures, and discusses their implications for rehabilitation. T T METHODS:The online databases of PubMed (MEDLINE), CINAHL, SPORTDiscus, and Scopus were searched (inception to September 2013). Studies pertaining to muscle performance, knee joint biomechanics, and performance-based measures of function following articular cartilage procedure in the knee were included. T T RESULTS:Sixteen articles met the specified inclusion criteria. Seven studies evaluated muscle performance, all showing persistent deficits in quadriceps femoris muscle strength for up to 7 years postprocedure. Quadriceps femoris strength deficits of greater than 20% were noted in 33% and 26% of individuals at 1 and 2 years following microfracture and autologous chondrocyte implantation (ACI), respectively. Two studies evaluated knee mechanics post-ACI, showing persistent deficits in knee kinematics and kinetics for up to 12 months postprocedure compared to uninjured individuals. Seven studies showed improved functional capacity (6-minute walk test) over time, and 3 studies showed persistent performance deficits during higher-level activities (single-leg hop test) for up to 6 years postprocedure. Five studies comparing weight-bearing protocols (accelerated versus traditional/current practice) following ACI found few differences between the groups in function and gait mechanics; however, persistent gait alterations were observed in both groups compared to uninjured individuals. T T CONCLUSION:Significant quadriceps femoris strength deficits, gait deviations, and functional deficits persist for 5 to 7 years following ACI and microfracture surgical procedures. Future research regarding rehabilitation interventions to help mitigate these deficits is...

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Articular Cartilage Lesions in 993 Consecutive Knee Arthroscopies

Abstract: Eleven percent of all knee arthroscopies show cartilage defects that may be suitable for cartilage repair procedures. However, the natural history of these lesions and the number of patients that will benefit from a cartilage repair procedure are so far unknown.

Cited by 508 publications

References 16 publications

The Feasibility of a 3-Month Active Rehabilitation Program for Patients With Knee Full-Thickness Articular Cartilage Lesions: The Oslo Cartilage Active Rehabilitation and Education Study

The Feasibility of a 3-Month Active Rehabilitation Program for Patients With Knee Full-Thickness Articular Cartilage Lesions: The Oslo Cartilage Active Rehabilitation and Education Study

Mapping tibiofemoral gonarthrosis: an MRI analysis of non-traumatic knee cartilage defects

Functional Outcomes After Surgical Management of Articular Cartilage Lesions in the Knee: A Systematic Literature Review to Guide Postoperative Rehabilitation

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