Articular Cartilage Repair of the Pediatric and Adolescent Knee with Regard to Minimal Clinically Important Difference: A Systematic Review

Abstract

Objective To perform a systematic review of clinical outcomes following microfracture (MFX), autologous chondrocyte implantation (ACI), osteochondral allograft transplantation (OCA), and osteochondral autograft transplantation system (OATS) to treat articular cartilage lesions in pediatric and adolescent patients. We sought to compare postoperative improvements for each cartilage repair method to minimal clinically important difference (MCID) thresholds. Design MEDLINE, Web of Science, Scopus, and Cochrane Library databases were searched for studies reporting MCID-validated outcome scores in a minimum of 5 patients ≤19 years treated for symptomatic knee chondral lesions with minimum 1-year follow-up. One-sample t tests were used to compare mean outcome score improvements to established MCID thresholds. Results Twelve studies reporting clinical outcomes on a total of 330 patients following cartilage repair were identified. The mean age of patients ranged from 13.7 to 16.7 years and the mean follow-up was 2.2 to 9.6 years. Six studies reported on ACI, 4 studies reported on MFX, 2 studies reported on OATS, and 1 study reported on OCA. ACI ( P < 0.001, P = 0.008) and OCA ( P < 0.001) showed significant improvement for International Knee Documentation Committee (IKDC) scores with regard to MCID while MFX ( P = 0.66) and OATS ( P = 0.11) did not. ACI ( P < 0.001) and OATS ( P = 0.010) both showed significant improvement above MCID thresholds for Lysholm scores. MFX ( P = 0.002) showed visual analog scale (VAS) pain score improvement above MCID threshold while ACI ( P = 0.037, P = 0.070) was equivocal. Conclusions Outcomes data on cartilage repair in the pediatric and adolescent knee are limited. This review demonstrates that all available procedures provide postoperative improvement above published MCID thresholds for at least one reported clinical pain or functional outcome score.

Matrix-Augmented Bone Marrow Stimulation With a Polyglycolic Acid Membrane With Hyaluronan vs Microfracture in Local Cartilage Defects of the Femoral Condyles: A Multicenter Randomized Controlled Trial

“…23 In the majority of clinical studies, clinical scores decrease at mid- and long-term follow-up. 23,36 It has also been shown that the outcome of MF is much better in small defects (<2-4 cm) 2,8,24,37 and has a worse outcome in localized cartilage defects >4.5 cm. 2,8…”

Patterns of Articular Cartilage Thickness in Pediatric and Adolescent Knees: A Magnetic Resonance Imaging–Based Study

“…The goal of OCA is to transplant an allograft with viable chondrocytes and underlying subchondral bone into a recipient socket. 6 Matching a graft to its donor site with respect to size and topography is important to minimizing articular step-off and maintaining near-normal contact pressure. 26 Studies have shown that an elevation of even 0.5 mm to 1 mm over the adjacent articular cartilage at the distal femur can increase contact pressures on the graft up to 50%.…”

“…5 Left untreated, these lesions can lead to progressive articular cartilage degeneration, early-onset osteoarthritis, and functional disability. [6][7][8] Understanding cartilage anatomy and morphology is important to evaluating and treating osteochondral and chondral lesions. Longitudinal reference data on cartilage development can aid in interpretation of knee cartilage under pathologic conditions in children and adolescents.…”

Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment

“…Best current evidence does not allow for valid comparison of outcomes associated with treatments for articular cartilage lesions. 60,70,86,161,162 As such, a systematic review by Farr et al concluded that for patients with symptomatic chondral injury, numerous techniques are available to relieve pain and improve function but until data from rigorous clinical trials are available, individual treatment decisions must still be guided by expert extrapolation of available literature using historically sound principles. 70 The authors of the present review article suggest that the peer-reviewed literature in conjunction with sound principles and basic science and preclinical data support the following guidance for clinical application to optimizing outcomes 3,18,28,61,74,117,142,[163][164][165][166][167][168][169][170][171][172] :…”