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. 2020 Mar 26;8(3):2325967120907343.
doi: 10.1177/2325967120907343. eCollection 2020 Mar.

An Expert Consensus Statement on the Management of Large Chondral and Osteochondral Defects in the Patellofemoral Joint

Jorge Chahla  1 , Betina B Hinckel  1 , Adam B Yanke  1 , Jack Farr  1 ; Metrics of Osteochondral Allografts (MOCA) Group; William D Bugbee  1 , James L Carey  1 , Brian J Cole  1 , Dennis C Crawford  1 , James E Fleischli  1 , Alan Getgood  1 , Andreas H Gomoll  1 , Simon Gortz  1 , Allan E Gross  1 , Deryk G Jones  1 , Aaron J Krych  1 , Christian Lattermann  1 , Bert R Mandelbaum  1 , Peter R Mandt  1 , Tom Minas  1 , Raffy Mirzayan  1 , Timothy S Mologne  1 , John D Polousky  1 , Matthew T Provencher  1 , Scott A Rodeo  1 , Oleg Safir  1 , Seth Lawrence Sherman  1 , Eric D Strauss  1 , Sabrina M Strickland  1 , Christopher J Wahl  1 , Riley J Williams 3rd  1
Affiliations

An Expert Consensus Statement on the Management of Large Chondral and Osteochondral Defects in the Patellofemoral Joint

Jorge Chahla et al. Orthop J Sports Med. .

Abstract

Background: Cartilage lesions of the patellofemoral joint constitute a frequent abnormality. Patellofemoral conditions are challenging to treat because of complex biomechanics and morphology.

Purpose: To develop a consensus statement on the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint using a modified Delphi technique.

Study design: Consensus statement.

Methods: A working group of 4 persons generated a list of statements related to the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint to form the basis of an initial survey for rating by a group of experts. The Metrics of Osteochondral Allografts (MOCA) expert group (composed of 28 high-volume cartilage experts) was surveyed on 3 occasions to establish a consensus on the statements. In addition to assessing agreement for each included statement, experts were invited to propose additional statements for inclusion or to suggest modifications of existing statements with each round. Predefined criteria were used to refine statement lists after each survey round. Statements reaching a consensus in round 3 were included within the final consensus document.

Results: A total of 28 experts (100% response rate) completed 3 rounds of surveys. After 3 rounds, 36 statements achieved a consensus, with over 75% agreement and less than 20% disagreement. A consensus was reached in 100.00% of the statements relating to functional anatomy of the patellofemoral joint, 88.24% relating to surgical indications, 100.00% relating to surgical technical aspects, and 100.00% relating to rehabilitation, with an overall consensus of 95.5%.

Conclusion: This study established a strong expert consensus document relating to the functional anatomy, surgical indications, donor graft considerations for osteochondral allografts, surgical technical aspects, and rehabilitation concepts for the management of large chondral and osteochondral defects in the patellofemoral joint. Further research is required to clinically validate the established consensus statements and better understand the precise indications for surgery as well as which techniques and graft processing/preparation methods should be used based on patient- and lesion-specific factors.

Keywords: Delphi; allograft; cartilage; consensus; osteochondral; patellofemoral.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: J.C. has received research support and consulting fees from Arthrex, Conmed, and Smith & Nephew. B.B.H. has received research support from Arthrex and educational support from Arthrex and Elite Orthopaedics. A.B.Y. has received research support from Arthrex, Orthogenesis, Medwest, and Vericel; educational support from Arthrex, Medwest, and Smith & Nephew; and consulting fees from Aastrom Biosciences, JRF Ortho, Olympus, PatientIQ, Smith & Nephew, and Sparta Biomedical. J.F. has received consulting fees from Osiris Therapeutics, Zimmer Biomet, ISTO Technologies, Ceterix Orthopaedics, Biomet, Genzyme, MedShape, and Sanofi-Aventis; has received speaking fees from Arthrex and Zimmer Biomet; has received royalties from Arthrex, DePuy, Organogenesis, Springer, and Thieme Medical Publishers; and has stock/stock options in MedShape and Ortho Regenerative Technologies. W.D.B. has received consulting fees from Arthrex, DePuy, Insight Medical, JRF Ortho, OrthAlign, and Smith & Nephew; has received royalties from DePuy, Smith & Nephew, and Zimmer Biomet; and has stock/stock options in Insight Medical, Moximed, and OrthAlign. B.J.C. has received research support from Aesculap/B. Braun, Arthrex, and Regentis Biomaterials; has received educational support from Medwest; has received consulting fees from Acumed, Anika Therapeutics, Arthrex, Bioventus, Flexion Therapeutics, Geistlich Pharma, Genzyme, Pacira Pharmaceuticals, Regentis Biomaterials, Smith & Nephew, Vericel, and Zimmer Biomet; has received speaking fees from Arthrex, Carticept Medical, LifeNet Health, and Pacira Pharmaceuticals; has received hospitality payments from GE Healthcare; has received royalties from Arthrex, DJO, Elsevier, and Operative Techniques in Sports Medicine; and has stock/stock options in BandGrip, Ossio, and Regentis Biomaterials. D.C.C. has received research support from Histogenics, JRF Ortho, Moximed, and Zimmer Biologics and consulting fees from Arthrosurface, DePuy, Histogenics, JRF Ortho, and Moximed. J.E.F. has received research support from Arthrex and Smith & Nephew; educational support from Linvatec, Peerless Surgical, and Zimmer Biomet; and consulting fees and speaking fees from Smith & Nephew. A.G. has received research support from Aesculap/B. Braun, Arthrex, DePuy, Eupraxia Pharmaceuticals, Musculoskeletal Transplant Foundation, Ossur, and Smith & Nephew; consulting fees from Collagen Solutions, Olympus, Ossur, and Smith & Nephew; speaking fees from Conmed Linvatec, Ossur, and Smith & Nephew; and royalties from Smith & Nephew. A.H.G. has received research support from JRF Ortho and Vericel; consulting fees from Aesculap, Geistlich Pharma, Genzyme, JRF Ortho, Moximed, Smith & Nephew, and Vericel; speaking fees from Aastrom Biosciences, LifeNet Health, and Vericel; and royalties from Organogenesis. S.G. has received educational support from Arthrex and Goode Surgical and honoraria from Vericel. A.E.G. has received consulting fees, speaking fees, and royalties from Zimmer Biomet and has stock/stock options in Intellijoint Surgical. D.G.J. has received research support from Genzyme and Sanofi-Aventis; has received educational support from Arthrex; has received consulting fees from Aastrom Biosciences, Acumed, Amniox Medical, DePuy/Medical Device Business Services, Flexion, Genzyme, Vericel, and Zimmer Biomet; has received speaking fees from Arthrex, Conmed Linvatec, Flexion, Genzyme, Mitek, Musculoskeletal Transplant Foundation, TissueTech, Vericel, and Zimmer Biomet; and is a board or committee member of the Musculoskeletal Transplant Foundation. A.J.K. has received research support from Aesculap/B. Braun, Arthrex, Ceterix Orthopaedics, and Histogenics; has received consulting fees from Arthrex, DePuy, JRF Ortho, and Vericel; has received speaking fees from Arthrex; and is a board or committee member of the Musculoskeletal Transplant Foundation. C.L. has received honoraria from Arthrosurface; consulting fees from Aastrom Biosciences, Genzyme, JRF Ortho, Samumed, Sanofi-Aventis, Vericel, and Zimmer Biomet; and speaking fees from Vericel. B.R.M. has received consulting fees from Arthrex, BioMarin Pharmaceutical, DePuy, and Exactech; speaking fees from Arthrex; and royalties from Arthrex. R.M. has received research support from Arthrex and DJO, has received educational support from Arthrex, has received speaking fees from Arthrex, has received royalties from Zimmer Biomet, and has stock/stock options in AlignMed. T.S.M. has received research support from JRF Ortho, educational support from Arthrex, consulting fees from JRF Ortho and MicroAire Surgical Instruments, and speaking fees from JRF Ortho. J.D.P. has received research support from Ossur, Sanofi-Aventis, and Vericel; consulting fees from JRF Ortho; and speaking fees from DePuy. M.T.P. has received consulting fees from Arthrex and JRF Ortho (AlloSource), speaking fees from Arthrex, and royalties from Arthrex and SLACK. S.A.R. has received consulting fees from Flexion, has received speaking fees from Smith & Nephew, has received honoraria from Fidia Pharma, has received royalties from Zimmer Biomet, and has stock/stock options in Ortho Regenerative Technologies. O.S. has received research support from DePuy and consulting fees from Zimmer Biomet. S.L.S. has received consulting fees and research support from Arthrex Inc; is a paid consultant for Ceterix Orthopaedics, CONMED Linvatec, Flexion Therapeutics, GLG Consulting, JRF Ortho, Moximed, Olympus, Vericel, Linvatec, and RTI Surgical; has received hospitality payments from Linvatec and Smith & Nephew; and has received a grant (indirect) from DJO. E.D.S. has received research support from CartiHeal, Fidia Pharma, and NuTech; consulting fees from Arthrex, Fidia Pharma, Flexion, JRF Ortho, Organogenesis, Smith & Nephew, and Vericel; speaking fees from Arthrex, Organogenesis, and Vericel; and royalties from Jaypee Brothers Medical Publishers. C.J.W. has received consulting fees from Arthrosurface and Smith & Nephew and speaking fees from Arthrex, Arthrosurface, and Smith & Nephew. R.J.W. has received research support from Histogenics; has received consulting fees from Arthrex, JRF Ortho, and Lipogems; has received speaking fees from Arthrex; has received royalties from Arthrex; and has stock/stock options in CyMedica Orthopedics, Gramercy Extremity Orthopedics, Pristine Surgical, and RecoverX. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Stacked leaning bar chart representing the breakdown in agreement levels in the third-round Delphi survey. Bars to the left of the y-axis indicate disagreement, with bars to the right indicating agreement.
See this image and copyright information in PMC

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