Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Mar 23;6(3):2325967118761871.
doi: 10.1177/2325967118761871. eCollection 2018 Mar.

Treatment of Failed Articular Cartilage Reconstructive Procedures of the Knee: A Systematic Review

Joseph D Lamplot  1 , Kevin A Schafer  1 , Matthew J Matava  1
Affiliations
Review

Treatment of Failed Articular Cartilage Reconstructive Procedures of the Knee: A Systematic Review

Joseph D Lamplot et al. Orthop J Sports Med. .

Abstract

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.

Keywords: autologous chondrocyte implantation; marrow stimulation techniques; microfracture; osteochondral allograft; osteochondral autograft; revision cartilage.

PubMed Disclaimer

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: M.J.M. is a paid consultant for Arthrex, Schwartz Biomedical, and Pacira Pharmaceuticals; has received research support from Arthrex and Breg; and has received other financial/material support from Pacira Pharmaceuticals.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram. OA, osteoarthritis.
See this image and copyright information in PMC

References

    1. Aroen A, Loken S, Heir S, et al. Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med. 2004;32(1):211–215. - PubMed
    1. Basad E, Ishaque B, Bachmann G, Sturz H, Steinmeyer J. Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):519–527. - PubMed
    1. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994;331(14):889–895. - PubMed
    1. Brophy RH, Wojahn RD, Lamplot JD. Cartilage restoration techniques for the patellofemoral joint. J Am Acad Orthop Surg. 2017;25(5):321–329. - PubMed
    1. Camp CL, Stuart MJ, Krych AJ. Current concepts of articular cartilage restoration techniques in the knee. Sports Health. 2014;6(3):265–273. - PMC - PubMed

LinkOut - more resources