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Changing trends in the use of cartilage restoration techniques for the patellofemoral joint: a systematic review.

Abstract

PURPOSE

The patellofemoral (PF) joint contains the thickest articular cartilage in the human body. Chondral lesions to this area are often misdiagnosed and can predispose to secondary osteoarthritis if left untreated. Treatment options range from arthroscopic debridement to cartilage restoration techniques such as microfracture (MFx), autologous chondrocyte implantation (ACI), and osteochondral autograft transplantation. The purpose of this study was to systematically assess the trends in surgical techniques, outcomes, and complications of cartilage restoration of the PF joint.

METHODS

This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The electronic databases PubMed, MEDLINE, and EMBASE were searched from January 1, 2007 to April 30, 2018. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. A two-proportion z test was used to determine whether the differences between the proportions of cartilage restoration techniques used from 2007 to 2012 and 2013-2018 were statistically significant.

RESULTS

Overall, 28 studies were identified, including 708 patients (824 knees) with a mean age of 39.5 ± 10.5 years and a mean follow-up of 39.1 ± 16.0 months. Majority of patients were treated with ACI (45.5%) and MFx (29.6%). A significant increase in the use of the third generation ACI occurred with a simultaneous decreased usage of the conventional MFx over the last 5 years (p < 0.001). All techniques had significant (p < 0.05) improvements in clinical outcomes. The overall complication rate was 9.2%, of which graft hypertrophy (2.7%) was the most prevalent.

CONCLUSIONS

ACI was the most common restoration technique. The use of third generation ACI has increased with a concurrent decline in the use of conventional MFx over the latter half of the past decade (p < 0.001). Overall, the various cartilage restoration techniques reported improvements in patient reported outcomes with low complication rates. Definitive conclusions on the optimal treatment remain elusive due to a lack of high-quality comparative studies.

LEVEL OF EVIDENCE

Level IV, Systematic Review of Level-II-IV studies.

Authors+Show Affiliations

Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.UPMC Center for Sports Medicine, 3200 S. Water St, Pittsburgh, PA, 15203, USA.Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada. ayenif@mcmaster.ca. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. ayenif@mcmaster.ca.

Pub Type(s)

Journal Article
Systematic Review

Language

eng

PubMed ID

30232541

Citation

Shanmugaraj, Ajaykumar, et al. "Changing Trends in the Use of Cartilage Restoration Techniques for the Patellofemoral Joint: a Systematic Review." Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, vol. 27, no. 3, 2019, pp. 854-867.
Shanmugaraj A, Coughlin RP, Kuper GN, et al. Changing trends in the use of cartilage restoration techniques for the patellofemoral joint: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2019;27(3):854-867.
Shanmugaraj, A., Coughlin, R. P., Kuper, G. N., Ekhtiari, S., Simunovic, N., Musahl, V., & Ayeni, O. R. (2019). Changing trends in the use of cartilage restoration techniques for the patellofemoral joint: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, 27(3), pp. 854-867. doi:10.1007/s00167-018-5139-4.
Shanmugaraj A, et al. Changing Trends in the Use of Cartilage Restoration Techniques for the Patellofemoral Joint: a Systematic Review. Knee Surg Sports Traumatol Arthrosc. 2019;27(3):854-867. PubMed PMID: 30232541.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changing trends in the use of cartilage restoration techniques for the patellofemoral joint: a systematic review. AU - Shanmugaraj,Ajaykumar, AU - Coughlin,Ryan P, AU - Kuper,Gabriel N, AU - Ekhtiari,Seper, AU - Simunovic,Nicole, AU - Musahl,Volker, AU - Ayeni,Olufemi R, Y1 - 2018/09/19/ PY - 2018/06/15/received PY - 2018/09/06/accepted PY - 2018/9/21/pubmed PY - 2018/9/21/medline PY - 2018/9/21/entrez KW - Cartilage restoration KW - Osteoarthritis KW - Osteochondral defect KW - Patellofemoral joint SP - 854 EP - 867 JF - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA JO - Knee Surg Sports Traumatol Arthrosc VL - 27 IS - 3 N2 - PURPOSE: The patellofemoral (PF) joint contains the thickest articular cartilage in the human body. Chondral lesions to this area are often misdiagnosed and can predispose to secondary osteoarthritis if left untreated. Treatment options range from arthroscopic debridement to cartilage restoration techniques such as microfracture (MFx), autologous chondrocyte implantation (ACI), and osteochondral autograft transplantation. The purpose of this study was to systematically assess the trends in surgical techniques, outcomes, and complications of cartilage restoration of the PF joint. METHODS: This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The electronic databases PubMed, MEDLINE, and EMBASE were searched from January 1, 2007 to April 30, 2018. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. A two-proportion z test was used to determine whether the differences between the proportions of cartilage restoration techniques used from 2007 to 2012 and 2013-2018 were statistically significant. RESULTS: Overall, 28 studies were identified, including 708 patients (824 knees) with a mean age of 39.5 ± 10.5 years and a mean follow-up of 39.1 ± 16.0 months. Majority of patients were treated with ACI (45.5%) and MFx (29.6%). A significant increase in the use of the third generation ACI occurred with a simultaneous decreased usage of the conventional MFx over the last 5 years (p < 0.001). All techniques had significant (p < 0.05) improvements in clinical outcomes. The overall complication rate was 9.2%, of which graft hypertrophy (2.7%) was the most prevalent. CONCLUSIONS: ACI was the most common restoration technique. The use of third generation ACI has increased with a concurrent decline in the use of conventional MFx over the latter half of the past decade (p < 0.001). Overall, the various cartilage restoration techniques reported improvements in patient reported outcomes with low complication rates. Definitive conclusions on the optimal treatment remain elusive due to a lack of high-quality comparative studies. LEVEL OF EVIDENCE: Level IV, Systematic Review of Level-II-IV studies. SN - 1433-7347 UR - https://www.unboundmedicine.com/medline/citation/30232541/Changing_trends_in_the_use_of_cartilage_restoration_techniques_for_the_patellofemoral_joint:_a_systematic_review_ L2 - https://dx.doi.org/10.1007/s00167-018-5139-4 DB - PRIME DP - Unbound Medicine ER -