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Title: Surgical treatments of cartilage defects of the knee: Systematic review of randomised controlled trials.
Epworth Authors: Bell, Stuart
Feller, Julian
Whitehead, Tim
Devitt, Brian
Other Authors: Webster, Kate
Keywords: Knee Surgery
Knee Cartilage Defects
Autologous Chondrocyte Implantation
Osteochondral Autologous Transplantation
Matrix-induced ACI
Cartilage Regenerative Techniques
Surgical Techniques
Surgical Outcomes
Musculoskeletal Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: May-2016
Publisher: Elsevier
Citation: Knee. 2017 Feb 8.
Abstract: BACKGROUND: The aim of this systematic review was to identify high quality randomised controlled trials (RCTs) and to provide an update on the most appropriate surgical treatments for knee cartilage defects. METHODS: Two reviewers independently searched three databases for RCTs comparing at least two different treatment techniques for knee cartilage defects. The search strategy used terms mapped to relevant subject headings of MeSH terms. Strict inclusion and exclusion criteria were used to identify studies with patients aged between 18 and 55 years with articular cartilage defects sized between one and 15cm2. Risk of bias was performed using a Coleman Methodology Score. Data extracted included patient demographics, defect characteristics, clinical outcomes, and failure rates. RESULTS: Ten articles were included (861 patients). Eight studies compared microfracture to other treatment; four to autologous chondrocyte implantation (ACI) or matrix-induced ACI (MACI); three to osteochondral autologous transplantation (OAT); and one to BST-Cargel. Two studies reported better results with OAT than with microfracture and one reported similar results. Two studies reported superior results with cartilage regenerative techniques than with microfracture, and two reported similar results. At 10years significantly more failures occurred with microfracture compared to OAT and with OAT compared to ACI. Larger lesions (>4.5cm2) treated with cartilage regenerative techniques (ACI/MACI) had better outcomes than with microfracture. CONCLUSIONS: Based on the evidence from this systematic review no single treatment can be recommended for the treatment of knee cartilage defects. This highlights the need for further RCTs, preferably patient-blinded, using an appropriate reference treatment or a placebo procedure.
DOI: 10.1016/j.knee.2016.12.002
PubMed URL:
ISSN: 0968-0160
Journal Title: The Knee
Type: Journal Article
Affiliated Organisations: School of Allied Health, La Trobe University, Melbourne, Australia.
OrthoSport Victoria, Richmond, Australia; School of Allied Health, La Trobe University, Melbourne, Australia
Orthosport Victoria, Epworth Hospital Richmond, Vic 3121, Australia.
Type of Clinical Study or Trial: Systematic Reviews
Appears in Collections:Musculoskeletal

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