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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2019

01-03-2019 | Knee

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

Authors: Ajaykumar Shanmugaraj, Ryan P. Coughlin, Gabriel N. Kuper, Seper Ekhtiari, Nicole Simunovic, Volker Musahl, Olufemi R. Ayeni

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2019

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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.
Appendix
Available only for authorised users
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Metadata
Title
Changing trends in the use of cartilage restoration techniques for the patellofemoral joint: a systematic review
Authors
Ajaykumar Shanmugaraj
Ryan P. Coughlin
Gabriel N. Kuper
Seper Ekhtiari
Nicole Simunovic
Volker Musahl
Olufemi R. Ayeni
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-5139-4

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