Treatment Selection in Articular Cartilage Lesions of the Knee: A Systematic Review

Joris E.J. Bekkers, Melanie Inklaar, Daniël B.F. Saris*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

140 Citations (Scopus)

Abstract

Background: Several treatment options are available to repair articular cartilage lesions of the knee; however, evidence-based parameters for treatment selection are lacking. Purpose: To identify parameters for valid treatment selection in the repair of articular cartilage lesions of the knee. Study Design: Systematic review. Methods: A systematic search was conducted in the databases EMBASE, MEDLINE, and the Cochrane collaboration. The retrieved articles were screened for relevance on title and abstract followed by a full-text study quality appraisal of the remaining articles. Eventually, a total of 4 randomized controlled trials were included. Results: Lesion size, activity level, and age were the influencing parameters for the outcome of articular cartilage repair surgery. Lesions greater than 2.5 cm2 should be treated with sophisticated techniques, such as autologous chondrocyte implantation or osteochondral autologous transplantation, while microfracture is a good first-line treatment option for smaller (<2.5 cm2) lesions. Patients who are active show better results after autologous chondrocyte implantation or osteochondral autologous transplantation when compared with microfracture. Younger patients (<30 years) seem to benefit more from any form of cartilage repair surgery compared with those over 30 years of age. Conclusion: Lesion size, activity level, and patient age are factors that should be considered in selecting treatment of articular cartilage lesions of the knee. In addition, these factors are a step toward evidence-based, instead of surgeon-preferred, treatment of articular cartilage lesions of the knee.

Original languageEnglish
Pages (from-to)148S-155S
JournalAmerican journal of sports medicine
Volume37
Issue number1_suppl
DOIs
Publication statusPublished - 1 Nov 2009
Externally publishedYes

Keywords

  • articular cartilage
  • autologous chondrocyte implantation (ACI)
  • cartilage repair
  • microfracture
  • osteochondral autologous transplantation (OAT)
  • treatment selection

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