Parameters identifying the risk of treatment failure after cartilage repair: a proposed treatment algorithm and pilot study

Abstract

Background: Cartilage defects often are treated with different techniques depending on the surgeon’s preferences and technical availability. A more systematic approach is therefore needed as a practical guide for surgeons regarding the choice of a suitable treatment for a particular patient. Methods: A retrospective descriptive study was done on 40 patients operated on with one of the following techniques: arthroscopic microfracture, periosteal transplantation and assisted matrix induced chondrogenesis (AMIC) technique. The average age of patients was 30.5 yr, with a minimum of 12 and a maximum of 54 yr. The average size of the injury was 2.67 cm2, with a minimum of 1 cm2 and a maximum of 6 cm2. The distribution of the injuries was as follows: trochlea 22.5%, medial femoral condyle 45%, patella 30%, and lateral femoral condyle 2.5%. Results: The proportion of patients who were not satisfied was 21% after 1-year follow-up. The proportion of reoperated patients was 12.5%. The proportion of patients operated on previously was 12.5%. The proportion of patients with multiple chondral defects was 7.5%. Younger patients fared better. Conclusions: Microfracture as the primary technique led to the most failures, but because of its simplicity and balanced clinical results, it should be used as the gold standard, especially in younger patients. Open techniques, AMIC, and periosteal transplantation should be reserved as second choice treatments after failure and as a first choice treatment for multiple lesions, larger defects, older patients, and for defects such as osteochondritis dissecans where there is a need for autologous cancellous bone transplantation.