Orthop J Sports Med. 2014 Oct 13;2(10):2325967114551528. doi: 10.1177/2325967114551528. eCollection 2014 Oct.
Cartilage Repair With or Without Meniscal Transplantation and Osteotomy for Lateral Compartment Chondral Defects of the Knee: Case Series With Minimum 2-Year Follow-up.
Orthopaedic journal of sports medicine
Joshua D Harris, Kristen Hussey, Bryan M Saltzman, Frank M McCormick, Hillary Wilson, Geoffrey D Abrams, Brian J Cole
Affiliations
Affiliations
- Center for Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA. ; Center for Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA.
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. ; Department of Orthopaedic Surgery, Veterans Administration Palo Alto, Stanford University, Palo Alto, California, USA.
PMID: 26535271
PMCID: PMC4555547 DOI: 10.1177/2325967114551528
Abstract
BACKGROUND: Treatment decision making for chondral defects in the knee is multifactorial. Articular cartilage pathology, malalignment, and meniscal deficiency must all be addressed to optimize surgical outcomes.
PURPOSE: To determine whether significant clinical improvements in validated clinical outcome scores are observed at minimum 2-year follow-up after articular cartilage repair of focal articular cartilage defects of the lateral compartment of the knee with or without concurrent distal femoral osteotomy and lateral meniscus transplant.
STUDY DESIGN: Case series; Level of evidence, 4.
METHODS: Symptomatic adults who underwent surgical treatment (microfracture, autologous chondrocyte implantation [ACI], osteochondral autograft or allograft) of full-thickness lateral compartment chondral defects of the knee with or without a postmeniscectomy compartment or valgus malalignment by a single surgeon with minimum 2-year follow-up were analyzed. Validated patient-reported and surgeon-measured outcomes were collected pre- and postsurgery. Pre- and postoperative outcomes were compared via Student t tests.
RESULTS: Thirty-five subjects (mean age, 29.6 ± 10.5 years) were analyzed. Patients had been symptomatic for 2.51 ± 3.52 years prior to surgery and had undergone 2.11 ± 1.18 surgeries prior to study enrollment, with a mean duration of follow-up of 3.65 ± 1.71 years. The mean defect size was 4.42 ± 2.06 cm(2). Surgeries included ACI (n = 18), osteochondral allograft (n = 14), osteochondral autograft (n = 2), and microfracture (n = 1). There were 18 subjects who underwent concomitant surgery (14 lateral meniscus transplant, 3 distal femoral osteotomy, and 1 combined). Statistically significant (P < .05) and clinically meaningful improvements were observed at final follow-up in Lysholm, subjective International Knee Documentation Committee (IKDS), Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, Short Form-12 (SF-12) scores, and patient satisfaction. At follow-up, patients undergoing isolated articular cartilage surgery had a significantly higher KOOS quality of life subscore than did those undergoing articular cartilage surgery and lateral meniscus transplant (P = .039). Otherwise, there were no significant postoperative differences between the isolated and combined surgery groups in any outcome score. Five patients underwent 6 reoperations (1 revision osteochondral allograft, 5 chondroplasties). No patient was converted to knee arthroplasty.
CONCLUSION: In patients with lateral compartment focal chondral defects with or without lateral meniscal deficiency and valgus malalignment, surgical cartilage repair and correction of concomitant pathology can significantly improve clinical outcomes at 2-year follow-up with no significant differences between isolated and combined surgery and a low rate of complications and reoperations.
Keywords: articular cartilage repair; distal femoral osteotomy; knee; lateral compartment; meniscus transplantation
References
- J Knee Surg. 2013 Jun;26(3):203-11 - PubMed
- Arthroscopy. 1997 Aug;13(4):456-60 - PubMed
- Knee. 2013 Jun;20(3):154-61 - PubMed
- Arthroscopy. 2013 Jul;29(7):1243-1252.e5 - PubMed
- Clin Orthop Relat Res. 1992 Jan;(274):248-64 - PubMed
- Int Orthop. 2010 Feb;34(2):249-54 - PubMed
- Am J Sports Med. 2009 May;37(5):890-7 - PubMed
- Arthroscopy. 2010 Dec;26(12):1655-61 - PubMed
- Arthroscopy. 2011 Mar;27(3):409-18 - PubMed
- Arthroscopy. 2005 Dec;21(12):1505-9 - PubMed
- J Bone Joint Surg Am. 2010 Sep 15;92(12):2220-33 - PubMed
- Am J Sports Med. 2009 Nov;37 Suppl 1:20S-23S - PubMed
- N Engl J Med. 1994 Oct 6;331(14):889-95 - PubMed
- Am J Sports Med. 2009 Oct;37(10):2053-63 - PubMed
- Am J Sports Med. 2007 Jun;35(6):907-14 - PubMed
- Arthroscopy. 2010 Jun;26(6):841-52 - PubMed
- Arthroscopy. 2002 Sep;18(7):730-4 - PubMed
- J Arthroplasty. 2007 Jun;22(4 Suppl 1):2-6 - PubMed
- J Bone Joint Surg Am. 2003;85-A Suppl 2:25-32 - PubMed
- Arthroscopy. 2007 May;23(5):503-8 - PubMed
- J Bone Joint Surg Am. 2009 Jul;91(7):1778-90 - PubMed
- Open Orthop J. 2012;6:313-9 - PubMed
- Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S208-28 - PubMed
- Knee Surg Sports Traumatol Arthrosc. 2014 Jan;22(1):174-80 - PubMed
- Acta Chir Orthop Traumatol Cech. 2008 Oct;75(5):382-6 - PubMed
- J Bone Joint Surg Am. 2005 Jan;87(1):127-33 - PubMed
- Arthroscopy. 2003 May-Jun;19(5):477-84 - PubMed
- Am J Sports Med. 1997 Sep-Oct;25(5):692-8 - PubMed
Publication Types