Is debridement beneficial for focal cartilage defects of the knee: data from the German Cartilage Registry (KnorpelRegister DGOU)

Abstract

Introduction Focal cartilage defects of the knee are often treated with arthroscopic debridement. Existing literature discussing the benefit of debridement for small articular cartilage lesions is scarce, especially if the debridement was not part of a combined operative cartilage procedure including meniscal and ligament repair. The purpose of this study was to examine the patients´ benefit after arthroscopic debridement for the treatment of isolated focal chondral defects with or without partial meniscus resection. Materials and methods Baseline (preoperative data) and 12-month follow-up of the five Knee Osteoarthritis Outcome Score (KOOS) subscores and the Numeric Rating Scale (NRS) for pain were analyzed in 126 patients undergoing debridement for focal chondral defects of the knee from the German Cartilage Registry. Sub-analysis for patients receiving isolated debridement and debridement with concomitant partial resection of meniscal pathologies was performed. Thus, four subgroups were created according to the treated defect size and presence of meniscal pathologies: “debridement-only < 2 cm 2 ”, “debridement-only > 2 cm 2 ”, “debridement and partial meniscus resection < 2 cm 2 ” and “debridement and partial meniscus resection > 2 cm 2 ”. Results KOOS-subscores showed a significant increase from baseline to follow-up evaluation ( p = 0.017–0.037) within the 126 patients. Sub-analysis showed significant improvement of all five KOOS-subscores in all three subgroups, except for the “debridement and partial meniscus resection > 2 cm 2 ”—group: in this group the KOOS subscores symptoms and sports showed no significant improvement. The NRS scores revealed no significant changes from baseline to 12-month follow-up within the four subgroups. Conclusion An overall benefit of arthroscopic debridement for focal cartilage lesions of the knee could be conducted. Isolated cartilage defects seem to benefit from debridement irrespectively of size. In patients with large cartilage defects (> 2 cm 2 ) and concurrent meniscal pathology expectation to improvement should be humbled. Effective reduction of pain by arthroscopic debridement remains unclear.

Advances in the treatment of exercise-related knee injuries

“…long term follows up of this treatment found improved clinical results and less serious degenerative changes [22]. Studies have shown that focal chondropathies treated with debridement having excellent functional results, no matter how large or deep the defect may be [23].…”

The role of arthroscopic debridement in the treatment of osteochondral lesions of the talus in the athlete

“…Weißenberger et al 3 from German Cartilage Registry data analysis including 126 patients with focal cartilage injuries at 1year follow-up, found significant KOOS score improvement in lesions less than 2 cm 2 in size with or without concomitant partial meniscectomy. However, patients with lesions less than 2 cm 2 in size with concomitant partial meniscectomy showed no significant benefit.…”

“…Arthroscopic debridement (AD) is one of the most common procedures in treating cartilage lesions. [1][2][3] AD encompasses the smoothening of fibrillation, flaps, or loose bodies of the cartilage surface and creating right-shouldered and stable margins using arthroscopic instruments like shavers or curettes. 4 However, despite its comprehensive implementation in the surgical treatment of osteochondral lesions of the talar dome (OLT) during the last century, its practice is rather abandoned nowadays.…”

After Chondroplasty, Patient Election to Proceed With Cartilage Transplantation Is Closely and Additively Associated With Preoperative AMADEUS (Area Measurement And DEpth Underlying Structure) Grade, Condylar Involvement, Knee Injury and Osteoarthritis Outcome Score Pain Score, and Veterans Rand 12-Item Health Survey Physical Score

“…Chondroplasty as a primary procedure for focal articular cartilage defects has demonstrated inconsistent results in the literature. 9 , 18 , 19 , 20 , 21 Specifically, chondroplasty was not shown to provide symptomatic benefit as compared with observation alone in a randomized controlled trial, 19 or provide significant benefit in delaying arthroplasty. 18 However, other series have suggested that chondroplasty for articular cartilage defects less than 2 cm 2 and in the absence of concurrent meniscal pathology may be efficacious.…”

“… 18 However, other series have suggested that chondroplasty for articular cartilage defects less than 2 cm 2 and in the absence of concurrent meniscal pathology may be efficacious. 9 , 21 Given the potential for meaningful clinical benefit and further informed decision-making following direct defect visualization, probing, and chondroplasty at the time of initial diagnostic arthroscopy, a single-stage definitive cartilage restoration procedure (OCA, minced cartilage allograft, etc.) may be found to be unnecessarily aggressive for certain patients.…”