Ryan P Coughlin1, Arnav Gupta2, Olawale A Sogbein3, Ajaykumar Shanmugaraj1, Adrian Z Kurz1, Nicole Simunovic1, Yi-Meng Yen4, Olufemi R Ayeni5. 1. Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, L8N 3Z5, Canada. 2. Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 3. Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada. 4. Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. 5. Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, L8N 3Z5, Canada. ayenif@mcmaster.ca.
Abstract
PURPOSE OF REVIEW: The purpose of this systematic review was to assess the outcomes and complications of described cartilage restoration techniques for cartilage defects (grades I to IV) in the adolescent knee. RECENT FINDINGS: Eleven studies satisfied the inclusion criteria comprising 307 patients with a mean follow-up of 4.6 years (range 1-18.9 years). Study patients were treated with autologous chondrocyte implantation (ACI) (n = 98, mean age 16.0), microfracture (MFx) (n = 36, mean age 15.4), internal fixation (n = 71, mean age 13.1), osteochondral allograft (OCA) transplantation (n = 78, mean age 16.4), and cartillage and excision (n = 24; mean age 14.2). ACI, MFx, OCA transplantation, and internal fixation showed significant improvement in knee functionality scores. The overall complication rate was 10.6% (n = 31). OCA transplantation had the highest complication rate (26.9%; n = 21/78). In summary, our review shows that ACI was the most commonly used technique. Furthermore, ACI, MFx, OCA transplantation, and internal fixation show the most promise in treating the adolescent population due to positive postoperative functional outcomes and low complication rates. However, future studies with large sample sizes, standardized outcome documentation, and long-term follow-up are required to confirm these preliminary results.
PURPOSE OF REVIEW: The purpose of this systematic review was to assess the outcomes and complications of described cartilage restoration techniques for cartilage defects (grades I to IV) in the adolescent knee. RECENT FINDINGS: Eleven studies satisfied the inclusion criteria comprising 307 patients with a mean follow-up of 4.6 years (range 1-18.9 years). Study patients were treated with autologous chondrocyte implantation (ACI) (n = 98, mean age 16.0), microfracture (MFx) (n = 36, mean age 15.4), internal fixation (n = 71, mean age 13.1), osteochondral allograft (OCA) transplantation (n = 78, mean age 16.4), and cartillage and excision (n = 24; mean age 14.2). ACI, MFx, OCA transplantation, and internal fixation showed significant improvement in knee functionality scores. The overall complication rate was 10.6% (n = 31). OCA transplantation had the highest complication rate (26.9%; n = 21/78). In summary, our review shows that ACI was the most commonly used technique. Furthermore, ACI, MFx, OCA transplantation, and internal fixation show the most promise in treating the adolescent population due to positive postoperative functional outcomes and low complication rates. However, future studies with large sample sizes, standardized outcome documentation, and long-term follow-up are required to confirm these preliminary results.
Authors: Simon Macmull; Michael T R Parratt; George Bentley; John A Skinner; Richard W J Carrington; Tim Morris; Tim W R Briggs Journal: Am J Sports Med Date: 2011-04-29 Impact factor: 6.202