Effect on Patient-Reported Outcomes of Debridement or Microfracture of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament–Reconstructed Knees

Røtterud, Jan Harald; Sivertsen, Einar Andreas; Forssblad, Magnus; Engebretsen, Lars; Årøen, Asbjørn

doi:10.1177/0363546515617468

Cited by 33 publications

(25 citation statements)

References 37 publications

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“…This patient cohort has previously been described in a study on the effects of surgical debridement or MF of concomitant full-thickness cartilage lesions on 2-year patient-reported outcomes. 24…”

Section: Methodsmentioning

confidence: 99%

A Controlled Comparison of Microfracture, Debridement, and No Treatment of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament–Reconstructed Knees: A Nationwide Prospective Cohort Study From Norway and Sweden of 368 Patients With 5-Year Follow-up

Ulstein

Årøen

Engebretsen

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:The effect of microfracture (MF) or surgical debridement of concomitant full-thickness cartilage lesions in anterior cruciate ligament–reconstructed knees on patient-reported outcomes remains to be determined.Purpose:To evaluate the effect of debridement or MF compared with no surgical treatment of concomitant full-thickness cartilage lesions on patient-reported outcomes 5 years after anterior cruciate ligament reconstruction (ACLR).Study Design:Cohort study; Level of evidence, 2.Methods:Included in this study were 644 patients who were registered in the Norwegian and the Swedish National Knee Ligament Registries from 2005 to 2008 as having undergone unilateral primary ACLR and having a concomitant full-thickness cartilage lesion (International Cartilage Repair Society [ICRS] grades 3-4). Of these patients, 129 were treated with debridement, 164 were treated with MF, and 351 received no surgical treatment simultaneously with ACLR. At 5-year follow-up, 368 (57%) patients completed results on the Knee injury and Osteoarthritis Outcome Score (KOOS). Multivariable linear regression was used to estimate the effect of surgical debridement or MF of concomitant full-thickness cartilage lesions on patient-reported outcomes 5 years after ACLR.Results:Compared with no surgical treatment, there were no unadjusted or adjusted effects of debridement or MF of concomitant full-thickness cartilage lesions on KOOS scores at 5-year follow-up.Conclusion:Compared with leaving concomitant full-thickness cartilage lesions untreated at the time of ACLR, debridement and MF showed no effect on patient-reported outcomes 5 years after surgery.

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Section: Methodsmentioning

confidence: 99%

A Controlled Comparison of Microfracture, Debridement, and No Treatment of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament–Reconstructed Knees: A Nationwide Prospective Cohort Study From Norway and Sweden of 368 Patients With 5-Year Follow-up

Ulstein

Årøen

Engebretsen

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…Røtterud et al demonstrated in knees undergoing anterior cruciate ligament reconstruction with associated grade 3 to 4 cartilage defects that no treatment of the lesion or simple debridement gave better long-term results than microfracture. 18 Whether these findings can be extrapolated to a large patient population or to the hip again is unknown.…”

Section: Arthroscopic Debridementmentioning

confidence: 99%

Hip Cartilage Restoration: Available Evidence and Current Trends

Collins

2018

J Hip Surg

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Treatment of cartilage pathology is controversial. In the hip, it is even more so as identification and treatment of early cartilage disease are relatively new and little evidence exists. With the advent and more widespread use of hip arthroscopy, easier access to the hip joint is available, and adequate treatment is possible with less morbidity. Many treatment options exist for cartilage lesions including nonoperative treatment, debridement, microfracture, acetabuloplasty, cartilage fixation, cartilage scaffolds, autologous chondrocyte implantation, and osteochondral grafting. While far from definitive, the current evidence suggests that smaller cartilage lesions (< 4 cm2) have good results with most treatments while larger lesions fare better with treatments that produce hyaline-like cartilage. The most cost-effective arthroscopic treatments of smaller cartilage lesions include acetabuloplasty and microfracture, while larger lesions should be considered for autologous matrix-induced chondrogenesis or matrix-assisted autologous chondrocyte implantation. Larger cartilage lesions with bone disease are more adequately treated with open procedures such as osteochondral grafting or total hip arthroplasty.

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“…Auch wenn weiterführende Untersuchungen zur Hüfte noch ausstehen, deuten die hier beschriebenen Erkenntnisse und Ergebnisse darauf hin, dass knochenmarkstimulierende Verfahren verschiedene biologische Defizite aufweisen, die auch im Hüftgelenk beobachtet werden können und die als problematisch gelten [45,72,96,97]. Unabhängig vom Gelenk sollte das Ziel einer biologischen Knorpelrekonstruktion die Wiederherstellung eines Knorpelgewebes sein, das in seiner Zusammensetzung, Struktur und Funktion dem gesunden hyalinen Knorpel möglichst nahekommt [64,98].…”

Section: Biologische Erkenntnisse Und Allgemeine Aspekte Zu Verschiedunclassified

Biologische Rekonstruktion lokalisiert vollschichtiger Knorpelschäden des Hüftgelenks: Empfehlungen der Arbeitsgemeinschaft „Klinische Geweberegeneration“ der DGOU und des Hüftkomitees der AGA

et al. 2017

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Symptomatic pre-arthritic deformities such as femoroacetabular impingement (FAI) or hip dysplasia often lead to localised cartilage defects and subsequently to osteoarthritis. The present review of the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Trauma (DGOU) and the hip committee of the AGA (German speaking Society for Arthroscopy and Joint Surgery) provides an overview of current knowledge of the diagnosis and surgical treatment of cartilage defects, in order to infer appropriate therapy recommendations for the hip. Review of FAI and resultant cartilage damage in the hip as reported in published study findings in the literature and discussion of the advantages and disadvantages of different surgical procedures to preserve the joint. Most published studies on the surgical treatment of cartilage damage in the hip report defects caused by cam-type FAI at the acetabulum. Development of these defects can be prevented by timely elimination of the relevant deformities. At present, current full-thickness cartilage defects are mostly treated with bone marrow-stimulating techniques such as microfracture (MFx), with or without a biomaterial, and matrix-assisted autologous chondrocyte transplantation (MACT). Osteochondral autologous transplantation (OAT) is not the treatment of choice for isolated full-thickness chondral defects at the hip, because of the unfavourable risk-benefit profile. Due to the relatively short history of cartilage repair surgery on the hip, the studies available on these procedures have low levels of evidence. However, it is already becoming obvious that the experience gained with the same procedures on the knee can be applied to the hip as well. For example, limited healing and regeneration of chondral defects after MFx can also be observed at the hip joint. The cartilage surface of the acetabulum, where FAI-related chondral lesions appear, is considerably smaller than the weight-bearing cartilage surface of the knee joint. However, as in the knee joint, MACT is the therapy of choice for full-thickness cartilage defects of more than 1.5 - 2 cm. Minimally invasive types of MACT (e.g. injectable chondrocyte implants) should be preferred in the hip joint. In cases where a single-stage procedure is indicated or there are other compelling reasons for not performing a MACT, a bone marrow-stimulating technique in combination with a biomaterial covering is preferable to standard MFx. For treatment of lesions smaller than 1.5 - 2 cm the indication for a single-stage procedure is wider. As with defects in the knee, it is not possible to determine a definite upper age limit for joint-preserving surgery or MACT in the hip, as the chronological age of patients does not necessarily correlate with their biological age or the condition of their joints. Advanced osteoarthritis of the hip is a contraindication for any kind of hip-preserving surgery. Long-term observations and prospective randomised studies like those carried out for other joints are necessary.

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Effect on Patient-Reported Outcomes of Debridement or Microfracture of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament–Reconstructed Knees

Cited by 33 publications

References 37 publications

A Controlled Comparison of Microfracture, Debridement, and No Treatment of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament–Reconstructed Knees: A Nationwide Prospective Cohort Study From Norway and Sweden of 368 Patients With 5-Year Follow-up

A Controlled Comparison of Microfracture, Debridement, and No Treatment of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament–Reconstructed Knees: A Nationwide Prospective Cohort Study From Norway and Sweden of 368 Patients With 5-Year Follow-up

Hip Cartilage Restoration: Available Evidence and Current Trends

Biologische Rekonstruktion lokalisiert vollschichtiger Knorpelschäden des Hüftgelenks: Empfehlungen der Arbeitsgemeinschaft „Klinische Geweberegeneration“ der DGOU und des Hüftkomitees der AGA

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