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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 01-11-2012 | Knee

Strategies for patient profiling in articular cartilage repair of the knee: a prospective cohort of patients treated by one experienced cartilage surgeon

Authors: Tommy S. de Windt, Sebastian Concaro, Anders Lindahl, Daniel B. F. Saris, Mats Brittberg

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2012

Abstract

Purpose

The purpose of this study was to report on the clinical outcome of a large heterogenic cartilage repair population treated with the profiling strategies of one experienced cartilage surgeon to provide evidence based tools for treatment selection in a clinical environment.

Methods

A total of 216 patients were identified in this prospective single-surgeon study. For the primary and secondary treatment of smaller defects, microfracture (MF) was used. Hyalograft C was used for first and second line larger defects, while carbon-fiber rod and pad implantations were used as a salvage procedure.

Results

Three years after the initial procedure, the clinical improvement was excellent for MF and Hyalograft C (P < 0.001) and good for carbon-fiber procedures (P < 0.05). Hyalograft C patients with prior anterior cruciate ligament reconstruction had less clinical improvement (P < 0.05), while MF patients with prior cartilage repair were more likely to fail (Odds Ratio 20.5, P < 0.05).

Conclusion

This is the first study that provides an assessment of the treatment strategies used by an experienced cartilage surgeon. A treatment algorithm for cartilage repair in a heterogenic population was created that based on the findings of this study could be implemented in a clinical environment.

Level of evidence

Prospective clinical case series, Level IV

Basad E, Ishaque B, Bachmann G, Sturz H, Steinmeyer J (2010) Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study. Knee Surg Sports Traumatol Arthrosc 18:519–527PubMedCrossRef

Bekkers JE, de Windt TS, Raijmakers NJ, Dhert WJ, Saris DB (2009) Validation of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for the treatment of focal cartilage lesions. Osteoarthr Cartil 17:1434–1439PubMedCrossRef

Bekkers JE, Inklaar M, Saris DB (2009) Treatment selection in articular cartilage lesions of the knee: a systematic review. Am J Sports Med 37(Suppl 1):148S–155SPubMedCrossRef

Benke G, Strzelczyk P, Kowalski M, Swiader P (2001) The use of carbon fibers to restore cartilage defects in the knee. Ortop Traumatol Rehabil 3:227–229PubMed

Brittberg M (2008) Autologous chondrocyte implantation-technique and long-term follow-up. Injury 39(Suppl 1):S40–S49

Brittberg M (2009) … more bricks to the building of cartilage knowledge? Knee Surg Sports Traumatol Arthrosc 17:1275–1277PubMedCrossRef

Brittberg M, Faxen E, Peterson L (1994) Carbon fiber scaffolds in the treatment of early knee osteoarthritis. A prospective 4-year followup of 37 patients. Clin Orthop Relat Res 307:155–164PubMed

Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331:889–895PubMedCrossRef

Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85-A(Suppl 2):58–69PubMed

10.

Chan YH (2004) Biostatistics 201: linear regression analysis. Singapore Med J 45:55–61PubMed

11.

Chan YH (2004) Biostatistics 202: logistic regression analysis. Singapore Med J 45:149–153PubMed

12.

de Windt TS, Bekkers JE, Creemers LB, Dhert WJ, Saris DB (2009) Patient profiling in cartilage regeneration: prognostic factors determining success of treatment for cartilage defects. Am J Sports Med 37(Suppl 1):58S–62SPubMedCrossRef

13.

Durbin J, Watson GS (1950) Testing for serial correlation in least squares regression I. Biometrika 37:409–428PubMed

14.

Engen CN, Engebretsen L, Aroen A (2010) Knee cartilage defect patients enrolled in randomized controlled trials are not representative of patients in orthopedic practice. Cartilage 1:312–319CrossRef

15.

Filardo G, Kon E, Di MA, Iacono F, Marcacci M (2011) Arthroscopic second-generation autologous chondrocyte implantation: a prospective 7-year follow-up study. Am J Sports Med 39:2153–2160PubMedCrossRef

16.

Gobbi A, Kon E, Berruto M, Filardo G, Delcogliano M, Boldrini L, Bathan L, Marcacci M (2009) Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: results at 5 years’ follow-up. Am J Sports Med 37:1083–1092PubMedCrossRef

17.

Granan LP, Bahr R, Lie SA, Engebretsen L (2009) Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: a cohort study based on the Norwegian National Knee Ligament Registry. Am J Sports Med 37:955–961PubMedCrossRef

18.

Gudas R, Simonaityte R, Cekanauskas E, Tamosiunas R (2009) A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children. J Pediatr Orthop 29:741–748PubMedCrossRef

19.

Harris JD, Brophy RH, Siston RA, Flanigan DC (2010) Treatment of chondral defects in the athlete’s knee. Arthroscopy 26:841–852PubMedCrossRef

20.

Jakobsen RB, Engebretsen L, Slauterbeck JR (2005) An analysis of the quality of cartilage repair studies. J Bone Joint Surg Am 87:2232–2239PubMedCrossRef

21.

Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grontvedt T, Solheim E, Strand T, Roberts S, Isaksen V, Johansen O (2004) Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 86-A:455–464PubMed

22.

Kon E, Filardo G, Condello V, Collarile M, Di MA, Zorzi C, Marcacci M (2011) Second-generation autologous chondrocyte implantation: results in patients older than 40 years. Am J Sports Med 39:1668–1675PubMedCrossRef

23.

Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M (2009) Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med 37:33–41PubMedCrossRef

24.

Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, Ghanem N, Uhl M, Sudkamp N (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22:1180–1186PubMedCrossRef

25.

Krishnan SP, Skinner JA, Bartlett W, Carrington RW, Flanagan AM, Briggs TW, Bentley G (2006) Who is the ideal candidate for autologous chondrocyte implantation? J Bone Joint Surg Br 88:61–64PubMedCrossRef

26.

Marcacci M, Berruto M, Brocchetta D, Delcogliano A, Ghinelli D, Gobbi A, Kon E, Pederzini L, Rosa D, Sacchetti GL, Stefani G, Zanasi S (2005) Articular cartilage engineering with Hyalograft C: 3-year clinical results. Clin Orthop Relat Res 435:96–105PubMedCrossRef

27.

Meister K, Cobb A, Bentley G (1998) Treatment of painful articular cartilage defects of the patella by carbon-fibre implants. J Bone Joint Surg Br 80:965–970PubMedCrossRef

28.

Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T (2009) Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med 37:902–908PubMedCrossRef

29.

Minas T, Gomoll AH, Solhpour S, Rosenberger R, Probst C, Bryant T (2010) Autologous chondrocyte implantation for joint preservation in patients with early osteoarthritis. Clin Orthop Relat Res 468:147–157PubMedCrossRef

30.

Mithoefer K, Hambly K, Della VS, Silvers H, Mandelbaum BR (2009) Return to sports participation after articular cartilage repair in the knee: scientific evidence. Am J Sports Med 37(Suppl 1):167S–176SPubMedCrossRef

31.

Nehrer S, Domayer S, Dorotka R, Schatz K, Bindreiter U, Kotz R (2006) Three-year clinical outcome after chondrocyte transplantation using a hyaluronan matrix for cartilage repair. Eur J Radiol 57:3–8PubMedCrossRef

32.

Nehrer S, Dorotka R, Domayer S, Stelzeneder D, Kotz R (2009) Treatment of full-thickness chondral defects with hyalograft C in the knee: a prospective clinical case series with 2 to 7 years’ follow-up. Am J Sports Med 37(Suppl 1):81S–87SPubMedCrossRef

33.

Nicholson P, Mulcahy D, Curtin B, McElwain JP (1998) Role of carbon fibre implants in osteochondral defects of the knee. Ir J Med Sci 167:86–88PubMedCrossRef

34.

Niemeyer P, Kostler W, Salzmann GM, Lenz P, Kreuz PC, Sudkamp NP (2010) Autologous chondrocyte implantation for treatment of focal cartilage defects in patients age 40 years and older: a matched-pair analysis with 2-year follow-up. Am J Sports Med 38:2410–2416PubMedCrossRef

35.

Niemeyer P, Pestka JM, Erggelet C, Steinwachs M, Salzmann GM, Sudkamp NP (2011) Comparison of arthroscopic and open assessment of size and grade of cartilage defects of the knee. Arthroscopy 27:46–51PubMedCrossRef

36.

Niemeyer P, Pestka JM, Kreuz PC, Erggelet C, Schmal H, Suedkamp NP, Steinwachs M (2008) Characteristic complications after autologous chondrocyte implantation for cartilage defects of the knee joint. Am J Sports Med 36:2091–2099PubMedCrossRef

37.

Niemeyer P, Steinwachs M, Erggelet C, Kreuz PC, Kraft N, Kostler W, Mehlhorn A, Sudkamp NP (2008) Autologous chondrocyte implantation for the treatment of retropatellar cartilage defects: clinical results referred to defect localisation. Arch Orthop Trauma Surg 128:1223–1231PubMedCrossRef

38.

Pavesio A, Abatangelo G, Borrione A, Brocchetta D, Hollander AP, Kon E, Torasso F, Zanasi S, Marcacci M (2003) Hyaluronan-based scaffolds (Hyalograft C) in the treatment of knee cartilage defects: preliminary clinical findings. Novartis Found Symp 249:203–217PubMedCrossRef

39.

Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E, Lindahl A (2000) Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res 374:212–234PubMedCrossRef

40.

Peterson L, Vasiliadis HS, Brittberg M, Lindahl A (2010) Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med 38:1117–1124PubMedCrossRef

41.

Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96PubMed

42.

Saris DB, Dhert WJ, Verbout AJ (2003) Joint homeostasis. The discrepancy between old and fresh defects in cartilage repair. J Bone Joint Surg Br 85:1067–1076PubMedCrossRef

43.

Saris DB, Vanlauwe J, Victor J, Almqvist KF, Verdonk R, Bellemans J, Luyten FP (2009) Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med 37(Suppl 1):10S–19SPubMedCrossRef

44.

Saris DB, Vanlauwe J, Victor J, Haspl M, Bohnsack M, Fortems Y, Vandekerckhove B, Almqvist KF, Claes T, Handelberg F, Lagae K, van der Bouwhede J, Vandenneucker H, Yang KG, Jelic M, Verdonk R, Veulemans N, Bellemans J, Luyten FP (2008) Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med 36:235–246

45.

Smith HJ, Richardson JB, Tennant A (2009) Modification and validation of the Lysholm Knee Scale to assess articular cartilage damage. Osteoarthr Cartil 17:53–58PubMedCrossRef

46.

Solheim E, Oyen J, Hegna J, Austgulen OK, Harlem T, Strand T (2010) Microfracture treatment of single or multiple articular cartilage defects of the knee: a 5-year median follow-up of 110 patients. Knee Surg Sports Traumatol Arthrosc 18:504–508PubMedCrossRef

47.

Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484PubMedCrossRef

48.

Van AD, Staes F, Van CD, Vanlauwe J, Bellemans J, Saris DB, Luyten FP (2010) Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 18:486–495CrossRef

49.

Zaslav K, Cole B, Brewster R, DeBerardino T, Farr J, Fowler P, Nissen C (2009) A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: results of the Study of the Treatment of Articular Repair (STAR) clinical trial. Am J Sports Med 37:42–55PubMedCrossRef

Title: Strategies for patient profiling in articular cartilage repair of the knee: a prospective cohort of patients treated by one experienced cartilage surgeon
Authors: Tommy S. de Windt
Sebastian Concaro
Anders Lindahl
Daniel B. F. Saris
Mats Brittberg
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2012
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-011-1855-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Strategies for patient profiling in articular cartilage repair of the knee: a prospective cohort of patients treated by one experienced cartilage surgeon

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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