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Treatment of Failed Articular Cartilage Reconstructive Procedures of the Knee: A Systematic Review
BACKGROUND: Symptomatic articular cartilage lesions of the knee are common and are being treated surgically with increasing frequency. While many studies have reported outcomes following a variety of cartilage restoration procedures, few have investigated outcomes of revision surgery after a failed...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871060/ https://www.ncbi.nlm.nih.gov/pubmed/29619397 http://dx.doi.org/10.1177/2325967118761871 |
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author | Lamplot, Joseph D. Schafer, Kevin A. Matava, Matthew J. |
author_facet | Lamplot, Joseph D. Schafer, Kevin A. Matava, Matthew J. |
author_sort | Lamplot, Joseph D. |
collection | PubMed |
description | BACKGROUND: Symptomatic articular cartilage lesions of the knee are common and are being treated surgically with increasing frequency. While many studies have reported outcomes following a variety of cartilage restoration procedures, few have investigated outcomes of revision surgery after a failed attempt at cartilage repair or reconstruction. PURPOSE: To investigate outcomes of revision cartilage restoration procedures for symptomatic articular cartilage lesions of the knee following a previously failed cartilage reconstructive procedure. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A literature search was performed by use of the PubMed, EMBASE, and MEDLINE/Ovid databases for relevant articles published between 1975 and 2017 that evaluated patients undergoing revision cartilage restoration procedure(s) and reported outcomes using validated outcome measures. For studies meeting inclusion criteria, relevant information was extracted. RESULTS: Ten studies met the inclusion criteria. Lesions most commonly occurred in the medial femoral condyle (MFC) (52.8%), with marrow stimulation techniques (MST) the index procedure most frequently performed (70.7%). Three studies demonstrated inferior outcomes of autologous chondrocyte implantation (ACI) following a previous failed cartilage procedure compared with primary ACI. One study comparing osteochondral allograft (OCA) transplant following failed microfracture (MFX) with primary OCA transplant demonstrated similar clinical outcomes and graft survival at midterm follow-up. No studies reported outcomes following osteochondral autograft transfer (OAT) or newer techniques. CONCLUSION: This systematic review of the literature reporting outcomes following revision articular cartilage restoration procedures (most commonly involving the MFC) demonstrated a high proportion of patients who underwent prior MST. Evidence is sufficient to suggest that caution should be taken in performing ACI in the setting of prior MST, likely secondary to subchondral bone compromise. OCA appears to be a good revision treatment option even if the subchondral bone has been violated from prior surgery or fracture. |
format | Online Article Text |
id | pubmed-5871060 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-58710602018-04-04 Treatment of Failed Articular Cartilage Reconstructive Procedures of the Knee: A Systematic Review Lamplot, Joseph D. Schafer, Kevin A. Matava, Matthew J. Orthop J Sports Med 32 BACKGROUND: Symptomatic articular cartilage lesions of the knee are common and are being treated surgically with increasing frequency. While many studies have reported outcomes following a variety of cartilage restoration procedures, few have investigated outcomes of revision surgery after a failed attempt at cartilage repair or reconstruction. PURPOSE: To investigate outcomes of revision cartilage restoration procedures for symptomatic articular cartilage lesions of the knee following a previously failed cartilage reconstructive procedure. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A literature search was performed by use of the PubMed, EMBASE, and MEDLINE/Ovid databases for relevant articles published between 1975 and 2017 that evaluated patients undergoing revision cartilage restoration procedure(s) and reported outcomes using validated outcome measures. For studies meeting inclusion criteria, relevant information was extracted. RESULTS: Ten studies met the inclusion criteria. Lesions most commonly occurred in the medial femoral condyle (MFC) (52.8%), with marrow stimulation techniques (MST) the index procedure most frequently performed (70.7%). Three studies demonstrated inferior outcomes of autologous chondrocyte implantation (ACI) following a previous failed cartilage procedure compared with primary ACI. One study comparing osteochondral allograft (OCA) transplant following failed microfracture (MFX) with primary OCA transplant demonstrated similar clinical outcomes and graft survival at midterm follow-up. No studies reported outcomes following osteochondral autograft transfer (OAT) or newer techniques. CONCLUSION: This systematic review of the literature reporting outcomes following revision articular cartilage restoration procedures (most commonly involving the MFC) demonstrated a high proportion of patients who underwent prior MST. Evidence is sufficient to suggest that caution should be taken in performing ACI in the setting of prior MST, likely secondary to subchondral bone compromise. OCA appears to be a good revision treatment option even if the subchondral bone has been violated from prior surgery or fracture. SAGE Publications 2018-03-23 /pmc/articles/PMC5871060/ /pubmed/29619397 http://dx.doi.org/10.1177/2325967118761871 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | 32 Lamplot, Joseph D. Schafer, Kevin A. Matava, Matthew J. Treatment of Failed Articular Cartilage Reconstructive Procedures of the Knee: A Systematic Review |
title | Treatment of Failed Articular Cartilage Reconstructive Procedures of the Knee: A Systematic Review |
title_full | Treatment of Failed Articular Cartilage Reconstructive Procedures of the Knee: A Systematic Review |
title_fullStr | Treatment of Failed Articular Cartilage Reconstructive Procedures of the Knee: A Systematic Review |
title_full_unstemmed | Treatment of Failed Articular Cartilage Reconstructive Procedures of the Knee: A Systematic Review |
title_short | Treatment of Failed Articular Cartilage Reconstructive Procedures of the Knee: A Systematic Review |
title_sort | treatment of failed articular cartilage reconstructive procedures of the knee: a systematic review |
topic | 32 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871060/ https://www.ncbi.nlm.nih.gov/pubmed/29619397 http://dx.doi.org/10.1177/2325967118761871 |
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