Cargando…

A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients

BACKGROUND: Focal cartilage defects are often debilitating, possess limited potential for regeneration, are associated with increased risk of osteoarthritis, and are predictive for total knee arthroplasty. Cartilage repair studies typically focus on the outcome in younger patients, but a high propor...

Descripción completa

Detalles Bibliográficos
Autores principales: Jeuken, Ralph M., van Hugten, Pieter P.W., Roth, Alex K., Timur, Ufuk Tan, Boymans, Tim A.E.J., van Rhijn, Lodewijk W., Bugbee, William D., Emans, Pieter J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8524698/
https://www.ncbi.nlm.nih.gov/pubmed/34676269
http://dx.doi.org/10.1177/23259671211031244
_version_ 1784585531623997440
author Jeuken, Ralph M.
van Hugten, Pieter P.W.
Roth, Alex K.
Timur, Ufuk Tan
Boymans, Tim A.E.J.
van Rhijn, Lodewijk W.
Bugbee, William D.
Emans, Pieter J.
author_facet Jeuken, Ralph M.
van Hugten, Pieter P.W.
Roth, Alex K.
Timur, Ufuk Tan
Boymans, Tim A.E.J.
van Rhijn, Lodewijk W.
Bugbee, William D.
Emans, Pieter J.
author_sort Jeuken, Ralph M.
collection PubMed
description BACKGROUND: Focal cartilage defects are often debilitating, possess limited potential for regeneration, are associated with increased risk of osteoarthritis, and are predictive for total knee arthroplasty. Cartilage repair studies typically focus on the outcome in younger patients, but a high proportion of treated patients are 40 to 60 years of age (ie, middle-aged). The reality of current clinical practice is that the ideal patient for cartilage repair is not the typical patient. Specific attention to cartilage repair outcomes in middle-aged patients is warranted. PURPOSE: To systematically review available literature on knee cartilage repair in middle-aged patients and include studies comparing results across different age groups. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic search was performed in EMBASE, MEDLINE, and the Cochrane Library database. Articles were screened for relevance and appraised for quality. RESULTS: A total of 21 articles (mean Coleman Methodology Score, 64 points) were included. Two out of 3 bone marrow stimulation (BMS) studies, including 1 using the microfracture technique, revealed inferior clinical outcomes in middle-aged patients in comparison with younger patients. Nine cell-based studies were included showing inconsistent comparisons of results across age groups for autologous chondrocyte implantation (ACI). Bone marrow aspirate concentrate showed age-independent results at up to 8 years of follow-up. A negative effect of middle age was reported in 1 study for both ACI and BMS. Four out of 5 studies on bone-based resurfacing therapies (allografting and focal knee resurfacing implants [FKRIs]) showed age-independent results up to 5 years. One study in only middle-aged patients reported better clinical outcomes for FKRIs when compared with biological repairs. CONCLUSION: Included studies were heterogeneous and had low methodological quality. BMS in middle-aged patients seems to only result in short-term improvements. More research is warranted to elucidate the ameliorating effects of cell-based therapies on the aging joint homeostasis. Bone-based therapies seem to be relatively insensitive to aging and may potentially result in effective joint preservation. Age subanalyses in cohort studies, randomized clinical trials, and international registries should generate more evidence for the large but underrepresented (in terms of cartilage repair) middle-aged population in the literature.
format Online
Article
Text
id pubmed-8524698
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-85246982021-10-20 A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients Jeuken, Ralph M. van Hugten, Pieter P.W. Roth, Alex K. Timur, Ufuk Tan Boymans, Tim A.E.J. van Rhijn, Lodewijk W. Bugbee, William D. Emans, Pieter J. Orthop J Sports Med Article BACKGROUND: Focal cartilage defects are often debilitating, possess limited potential for regeneration, are associated with increased risk of osteoarthritis, and are predictive for total knee arthroplasty. Cartilage repair studies typically focus on the outcome in younger patients, but a high proportion of treated patients are 40 to 60 years of age (ie, middle-aged). The reality of current clinical practice is that the ideal patient for cartilage repair is not the typical patient. Specific attention to cartilage repair outcomes in middle-aged patients is warranted. PURPOSE: To systematically review available literature on knee cartilage repair in middle-aged patients and include studies comparing results across different age groups. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic search was performed in EMBASE, MEDLINE, and the Cochrane Library database. Articles were screened for relevance and appraised for quality. RESULTS: A total of 21 articles (mean Coleman Methodology Score, 64 points) were included. Two out of 3 bone marrow stimulation (BMS) studies, including 1 using the microfracture technique, revealed inferior clinical outcomes in middle-aged patients in comparison with younger patients. Nine cell-based studies were included showing inconsistent comparisons of results across age groups for autologous chondrocyte implantation (ACI). Bone marrow aspirate concentrate showed age-independent results at up to 8 years of follow-up. A negative effect of middle age was reported in 1 study for both ACI and BMS. Four out of 5 studies on bone-based resurfacing therapies (allografting and focal knee resurfacing implants [FKRIs]) showed age-independent results up to 5 years. One study in only middle-aged patients reported better clinical outcomes for FKRIs when compared with biological repairs. CONCLUSION: Included studies were heterogeneous and had low methodological quality. BMS in middle-aged patients seems to only result in short-term improvements. More research is warranted to elucidate the ameliorating effects of cell-based therapies on the aging joint homeostasis. Bone-based therapies seem to be relatively insensitive to aging and may potentially result in effective joint preservation. Age subanalyses in cohort studies, randomized clinical trials, and international registries should generate more evidence for the large but underrepresented (in terms of cartilage repair) middle-aged population in the literature. SAGE Publications 2021-10-15 /pmc/articles/PMC8524698/ /pubmed/34676269 http://dx.doi.org/10.1177/23259671211031244 Text en © The Author(s) 2021 https://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 (https://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 Article
Jeuken, Ralph M.
van Hugten, Pieter P.W.
Roth, Alex K.
Timur, Ufuk Tan
Boymans, Tim A.E.J.
van Rhijn, Lodewijk W.
Bugbee, William D.
Emans, Pieter J.
A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients
title A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients
title_full A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients
title_fullStr A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients
title_full_unstemmed A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients
title_short A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients
title_sort systematic review of focal cartilage defect treatments in middle-aged versus younger patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8524698/
https://www.ncbi.nlm.nih.gov/pubmed/34676269
http://dx.doi.org/10.1177/23259671211031244
work_keys_str_mv AT jeukenralphm asystematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT vanhugtenpieterpw asystematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT rothalexk asystematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT timurufuktan asystematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT boymanstimaej asystematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT vanrhijnlodewijkw asystematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT bugbeewilliamd asystematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT emanspieterj asystematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT jeukenralphm systematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT vanhugtenpieterpw systematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT rothalexk systematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT timurufuktan systematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT boymanstimaej systematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT vanrhijnlodewijkw systematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT bugbeewilliamd systematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients
AT emanspieterj systematicreviewoffocalcartilagedefecttreatmentsinmiddleagedversusyoungerpatients