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Current Reviews in Musculoskeletal Medicine

Erschienen in:

26.11.2019 | Outcomes Research in Orthopedics (O Ayeni, Section Editor)

Cartilage Restoration in the Adolescent Knee: a Systematic Review

verfasst von: Ryan P. Coughlin, Arnav Gupta, Olawale A. Sogbein, Ajaykumar Shanmugaraj, Adrian Z. Kurz, Nicole Simunovic, Yi-Meng Yen, Olufemi R. Ayeni

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 4/2019

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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).

Summary

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.

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Zurück zum Zitat • DiBartola AC, Wright BM, Magnussen RA, Flanigan DC. Clinical outcomes after autologous chondrocyte implantation in adolescents’ knees: a systematic review. Arthrosc J Arthrosc Relat Surg. 2016;32(9):1905–16. https://doi.org/10.1016/j.arthro.2016.03.007Purpose: To perform a systematic review of the use of autologous chondrocyte implantation (ACI) in the adolescent knee. Specific aims: (1) quantify clinical outcomes of ACI in adolescent knees, (2) identify lesion and patient factors that correlate with clinical outcome, and (3) determine the incidence of complications of ACI in adolescents. Methods: PubMed, MEDLINE, SCOPUS, CINAHL, and Cochrane Collaboration Library databases were searched systematically. Outcome scores recorded included the International Knee Documentation Committee score, the International Cartilage Repair Society score, the Knee Injury and Osteoarthritis Outcome score, the visual analog scale, the Bentley Functional Rating score, the Modified Cincinnati Rating System, Tegner activity Lysholm scores, and return athletics. Outcome scores were compared among studies based on the proportion of adolescents achieving specific outcome quartiles at a minimum of 1-year follow-up. The methodological quality of studies was evaluated by Coleman methodology scores (CMSs). Results: Five studies reported on 115 subjects who underwent ACI with periosteal cover (ACI-P; 95, 83%), ACI with type I/type III collagen cover (ACI-C; 6, 5%), or matrix-induced ACI (MACI; 14, 12%). The mean patient age was 16.2 years (range, 11 years to 21 years). All studies were case series. Follow-up ranged from 12 to 74 months (mean, 52.3 months). The mean defect size was 5.3 cm 2(range, 0.96 cm 2to 14 cm 2). All studies reported improvement in clinical outcomes scores. Graft hypertrophy was the most common complication (7.0%). The mean preoperative clinical outcome percentage (based on the percentage of outcome scale used) was 37% (standard deviation (SD), 18.9%), and the mean postoperative clinical outcome percentage was 72.7% (SD, 16.9%). The overall percentage increase in clinical outcome scores was 35.7% (SD, 14.2%). The mean CMS was 47.8 (SD, 8.3). Conclusions: Cartilage repair in adolescent knees using ACI provides success across different clinical outcomes measures. The only patient- or lesion-specific factor that influenced clinical outcome was the shorter duration of preoperative symptoms. Level of evidence: level IV, a systemic review of level I–IV studies. CrossRef • DiBartola AC, Wright BM, Magnussen RA, Flanigan DC. Clinical outcomes after autologous chondrocyte implantation in adolescents’ knees: a systematic review. Arthrosc J Arthrosc Relat Surg. 2016;32(9):1905–16. https://doi.org/10.1016/j.arthro.2016.03.007Purpose: To perform a systematic review of the use of autologous chondrocyte implantation (ACI) in the adolescent knee. Specific aims: (1) quantify clinical outcomes of ACI in adolescent knees, (2) identify lesion and patient factors that correlate with clinical outcome, and (3) determine the incidence of complications of ACI in adolescents. Methods: PubMed, MEDLINE, SCOPUS, CINAHL, and Cochrane Collaboration Library databases were searched systematically. Outcome scores recorded included the International Knee Documentation Committee score, the International Cartilage Repair Society score, the Knee Injury and Osteoarthritis Outcome score, the visual analog scale, the Bentley Functional Rating score, the Modified Cincinnati Rating System, Tegner activity Lysholm scores, and return athletics. Outcome scores were compared among studies based on the proportion of adolescents achieving specific outcome quartiles at a minimum of 1-year follow-up. The methodological quality of studies was evaluated by Coleman methodology scores (CMSs). Results: Five studies reported on 115 subjects who underwent ACI with periosteal cover (ACI-P; 95, 83%), ACI with type I/type III collagen cover (ACI-C; 6, 5%), or matrix-induced ACI (MACI; 14, 12%). The mean patient age was 16.2 years (range, 11 years to 21 years). All studies were case series. Follow-up ranged from 12 to 74 months (mean, 52.3 months). The mean defect size was 5.3 cm ²(range, 0.96 cm ²to 14 cm ²). All studies reported improvement in clinical outcomes scores. Graft hypertrophy was the most common complication (7.0%). The mean preoperative clinical outcome percentage (based on the percentage of outcome scale used) was 37% (standard deviation (SD), 18.9%), and the mean postoperative clinical outcome percentage was 72.7% (SD, 16.9%). The overall percentage increase in clinical outcome scores was 35.7% (SD, 14.2%). The mean CMS was 47.8 (SD, 8.3). Conclusions: Cartilage repair in adolescent knees using ACI provides success across different clinical outcomes measures. The only patient- or lesion-specific factor that influenced clinical outcome was the shorter duration of preoperative symptoms. Level of evidence: level IV, a systemic review of level I–IV studies. CrossRef

Perera J, Gikas P, Bentley G. The present state of treatments for articular cartilage defects in the knee. Ann R Coll Surg Engl. 2012;94(6):381–7. https://doi.org/10.1308/003588412X13171221592573.CrossRefPubMedPubMedCentral

Habelt S, Hasler CC, Steinbrück K, Majewski M. Sport injuries in adolescents. Orthop Rev. 2011;3(2):18. https://doi.org/10.4081/or.2011.e18.CrossRef

Kaszkin-Bettag M. Is autologous chondrocyte implantation (ACI) an adequate treatment option for repair of cartilage defects in paediatric patients? Drug Discov Today. 2013;18(15–16):740–7. https://doi.org/10.1016/j.drudis.2013.04.007.CrossRefPubMed

Siparsky P, Bailey J, Dale K, Klement M, Taylor D. Open reduction internal fixation of isolated chondral fragments without osseous attachment in the knee. Orthop J Sports Med. 2017;5:232596711769628. https://doi.org/10.1177/2325967117696281.CrossRef

Kung J. From systematic reviews to clinical recommendations for evidence- based health care: validation of Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) for grading of clinical relevance. Open Dent J. 2010;4(2):84–91. https://doi.org/10.2174/1874210601004020084.CrossRefPubMedPubMedCentral

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:https://doi.org/10.1371/journal.pmed.1000097 CrossRefPubMedPubMedCentral

Wright JG, Swiontkowski MF, Heckman JD. Introducing levels of evidence to the journal. J Bone Joint Surg Am. 2003;85-A(1):1–3.CrossRef

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–6.CrossRefPubMed

10.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74. https://doi.org/10.2307/2529310.CrossRefPubMed

11.

Fabricant PD, Yen Y-M, Kramer DE, Kocher MS, Micheli LJ, Lawrence JTR, et al. Fixation of traumatic chondral-only fragments of the knee in pediatric and adolescent athletes: a retrospective multicenter report. Orthop J Sports Med. 2018;6(2):232596711775314. https://doi.org/10.1177/2325967117753140.CrossRef

12.

Pennock AT, Murphy RT, Bugbee W. Osteochondral allografting for knee lesions in the pediatric and adolescent population. Orthop J Sports Med. 2013;1(4_suppl):2325967113S0007. https://doi.org/10.1177/2325967113S00076.CrossRef

13.

Murphy RT, Pennock AT, Bugbee WD. Osteochondral allograft transplantation of the knee in the pediatric and adolescent population. Am J Sports Med. 2014;42(3):635–40. https://doi.org/10.1177/0363546513516747.CrossRefPubMed

14.

Ogura T, Bryant T, Minas T. Long-term outcomes of autologous chondrocyte implantation in adolescent patients. Am J Sports Med. 2017;45(5):1066–74. https://doi.org/10.1177/0363546516682492.CrossRefPubMed

15.

Niethammer TR, Holzgruber M, Gülecyüz MF, Weber P, Pietschmann MF, Müller PE. Matrix based autologous chondrocyte implantation in children and adolescents: a match paired analysis in a follow-up over three years post-operation. Int Orthop. 2017;41(2):343–50. https://doi.org/10.1007/s00264-016-3321-1.CrossRefPubMed

16.

Macmull S, MT Parratt, Bentley G, et al. Autologous chondrocyte implantation in the adolescent knee. Am J Sports Med 2011;39(8):1723–1731. doi:https://doi.org/10.1177/0363546511404202.CrossRefPubMed

17.

Chotel F, Knorr G, Simian E, Dubrana F, Versier G. Knee osteochondral fractures in skeletally immature patients: French multicenter study. Orthop Traumatol Surg Res. 2011;97(8):S154–9. https://doi.org/10.1016/j.otsr.2011.09.003.CrossRefPubMed

18.

Schmal H, Strohm PC, Niemeyer P, Reising K, Kuminack K, Sudkamp NP. Fractures of the patella in children and adolescents. Acta Orthop Belg. 2010;76(5):644–50.PubMed

19.

20.

Mithoefer K, Peterson L, Zenobi-Wong M, Mandelbaum BR. Cartilage issues in football—today’s problems and tomorrow’s solutions. Br J Sports Med. 2015;49(9):590–6. https://doi.org/10.1136/bjsports-2015-094772.CrossRefPubMed

21.

Torrie AM, Kesler WW, Elkin J, Gallo RA. Osteochondral allograft. Curr Rev Musculoskelet Med. 2015;8(4):413–22. https://doi.org/10.1007/s12178-015-9298-3.CrossRefPubMedPubMedCentral

22.

• Valtanen RS, Arshi A, Kelley BV, Fabricant PD, Jones KJ. Articular cartilage repair of the pediatric and adolescent knee with regard to minimal clinically important difference: a systematic review. Cartilage. 2018:194760351878350. https://doi.org/10.1177/1947603518783503Objective: To perform a systematic review of clinical outcomes following microfracture (MFx), autologous chondrocyte implantation (ACI), osteochondral allograft (OCA) transplantation, and osteochondral autograft transplantation system (OATS) to treat articular cartilage lesions in pediatric and adolescent patients. We sought to compare postoperative improvements for each cartilage repair method to minimal clinically important difference (MCID) thresholds. Design: MEDLINE, Web of Science, Scopus, and Cochrane Library databases were searched for studies reporting MCID-validated outcome scores in a minimum of 5 patients of age ≤ 19 years who were treated for symptomatic knee chondral lesions with a minimum of 1-year follow-up. One-samplettests were used to compare mean outcome score improvements to established MCID thresholds. Results: Twelve studies reporting clinical outcomes on a total of 330 patients following cartilage repair were identified. The mean age of patients ranged from 13.7 to 16.7 years, and the mean follow-up was 2.2 years to 9.6 years. Six studies reported on ACI, 4 studies reported on MFx, 2 studies reported on OATS, and 1 study reported on OCA transplantation. ACI (p< 0.001,p= 0.008) and OCA transplantation (p< 0.001) showed significant improvement for International Knee Documentation Committee (IKDC) scores with regard to MCID while MFx (p= 0.66) and OATS (p= 0.11) did not. ACI (p< 0.001) and OATS (p= 0.010) both showed significant improvement above MCID thresholds for Lysholm scores. MFx (p= 0.002) showed visual analog scale (VAS) pain score improvement above MCID threshold while ACI (p= 0.037,p= 0.070) was equivocal. Conclusions: Outcome data on cartilage repair in the pediatric and adolescent knee are limited. This review demonstrates that all available procedures provide postoperative improvement above published MCID thresholds for at least one reported clinical pain or functional outcome score. CrossRefPubMedPubMedCentral

23.

• Pareek A, Carey JL, Reardon PJ, Peterson L, Stuart MJ, Krych AJ. Long-term outcomes after autologous chondrocyte implantation: a systematic review at mean follow-up of 11.4 years. Cartilage. 2016;7(4):298–308. https://doi.org/10.1177/1947603516630786Objective: Autologous chondrocyte implantation (ACI) has not been proven to be durable over the long term. The purpose of this systematic review was (1) to evaluate activity level and knee function, (2) to evaluate reoperation and failure rates, and (3) to analyze risk factors for reoperation and failure of ACI at minimum long-term follow-up. Design: A comprehensive review was performed for studies with long-term outcomes after ACI for cartilage defect repair. Studies reported outcome scores such as Tegner score, Lysholm score, and International Knee Documentation Society (IKDC) score along with rates of failure and reoperation. Modified Coleman methodology scores were calculated to assess study methodological quality. Results: Nine studies with a total of 771 patients with a mean age of 33.4 ± 2.5 years, mean defect size of 5.9 ± 1.6 cm ², and mean follow-up of 11.4 years were included. The Tegner score, Lysholm score, and IKDC score change from preoperative to final follow-up was 1.1 point (95% CI 0.8–1.4,p< 0.001), 24.9 points (95% CI 18.8–31,p< 0.001), and 16.5 points (95% CI 5.4–27.5,p< 0.01), respectively. The mean failure and reoperation rates were 18% and 37%, respectively. Increased age and lesion size (> 4.5 cm ²) were significantly correlated with an increased risk of reoperation and failure. Conclusions: Overall, ACI demonstrated successful outcomes in 82% of patients over the long term. Increased patient age and lesion size greater than 4.5 cm ²were risk factors for a higher reoperation and failure rate. Nonetheless, this review is limited by heterogeneity in surgical technique and by lesion and patient characteristics. CrossRefPubMedPubMedCentral

24.

Harris JD, Siston RA, Brophy RH, Lattermann C, Carey JL, Flanigan DC. Failures, re-operations, and complications after autologous chondrocyte implantation—a systematic review. Osteoarthr Cartil. 2011;19(7):779–91. https://doi.org/10.1016/j.joca.2011.02.010.CrossRef

25.

Salzmann GM, Sah B-R, Schmal H, Niemeyer P, Sudkamp NP. Microfracture for treatment of knee cartilage defects in children and adolescents. Pediatr Rep. 2012;4(2):21. https://doi.org/10.4081/pr.2012.e21.CrossRef

26.

Seo S-S, Kim C-W, Jung D-W. Management of focal chondral lesion in the knee joint. Knee Surg Relat Res. 2011;23(4):185–96. https://doi.org/10.5792/ksrr.2011.23.4.185.CrossRef

27.

Kang H, Li J, Chen X-X, Wang T, Liu S-C, Li H-C. Fixation versus excision of osteochondral fractures after patellar dislocations in adolescent patients: a retrospective cohort study. Chin Med J. 2018;131(11):1296–301. https://doi.org/10.4103/0366-6999.232800.CrossRefPubMedPubMedCentral

Titel: Cartilage Restoration in the Adolescent Knee: a Systematic Review
verfasst von: Ryan P. Coughlin
Arnav Gupta
Olawale A. Sogbein
Ajaykumar Shanmugaraj
Adrian Z. Kurz
Nicole Simunovic
Yi-Meng Yen
Olufemi R. Ayeni
Publikationsdatum: 26.11.2019
Verlag: Springer US
Erschienen in: Current Reviews in Musculoskeletal Medicine / Ausgabe 4/2019
Elektronische ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-019-09595-x

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Springer Medizin

Cartilage Restoration in the Adolescent Knee: a Systematic Review

Abstract

Purpose of Review

Recent Findings

Summary

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Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

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