Original Article| Volume 35, ISSUE 1, P138-146, January 2019

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Management of Chondral Lesions of the Knee: Analysis of Trends and Short-Term Complications Using the National Surgical Quality Improvement Program Database

Published:November 22, 2018DOI:


      To provide updated surgical trends of cartilage procedures differentiated by the classic groups of palliative, repair, and restorative modalities.


      The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2010-2016 for the following cartilage procedures: chondroplasty, microfracture, arthroscopic osteochondral autograft or allograft transplantation, open osteochondral autograft or allograft transplantation, and autologous chondrocyte implantation. Demographic variables and short-term (30-day) complications were analyzed with 1-way analysis of variance and post hoc analysis. Linear regression analysis was performed to analyze trends over time.


      A total of 15,609 procedures performed between 2010 and 2016 were analyzed. On average, 342.2 ± 27.9 cartilage procedures were performed per 100,000 operations. There was a linear increase in the management of overall cartilage procedures per 100,000 operations (P = .002). There were also linear increases in arthroscopic osteochondral autograft transplantation, arthroscopic osteochondral allograft transplantation, open osteochondral autograft transplantation, open osteochondral allograft transplantation, and autologous chondrocyte implantation (P < .001, P = .037, P = .001, P = .006, and P = .002, respectively). Meniscectomy was the most frequently performed concomitant procedure (9.7%-64.2% of cases). Chondroplasty and microfracture showed no change in frequency over time (P = .140 and P = .720, respectively). The overall complication rate was 2.1% for chondroplasty, 1.4% for microfracture, 1.8% for arthroscopic osteochondral autograft transplantation, 1.0% for arthroscopic osteochondral allograft transplantation, 1.4% for open osteochondral autograft transplantation, 1.1% for open osteochondral allograft transplantation, and 0.75% for autologous chondrocyte implantation. Deep vein thrombosis was the most common complication, occurring in 0.4% to 1.0% of cases. No statistically significant difference was found in complication rates between procedures (P = .105).


      Cartilage restoration is becoming an increasingly popular modality to address chondral defects. Minimal complication rates suggest that these procedures may be safely performed concomitantly with other interventions.

      Level of Evidence

      Level IV, retrospective database analysis.
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        • Noyes F.R.
        • Bassett R.W.
        • Grood E.S.
        • Butler D.L.
        Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries.
        J Bone Joint Surg Am. 1980; 62: 687-695, 757
        • Alford J.W.
        • Cole B.J.
        Cartilage restoration, part 1: Basic science, historical perspective, patient evaluation, and treatment options.
        Am J Sports Med. 2005; 33: 295-306
        • Messner K.
        • Maletius W.
        The long-term prognosis for severe damage to weight-bearing cartilage in the knee: A 14-year clinical and radiographic follow-up in 28 young athletes.
        Acta Orthop Scand. 1996; 67: 165-168
        • Mow V.C.
        • Holmes M.H.
        • Lai W.M.
        Fluid transport and mechanical properties of articular cartilage: A review.
        J Biomech. 1984; 17: 377-394
        • Redondo M.L.
        • Beer A.J.
        • Yanke A.B.
        Cartilage restoration: Microfracture and osteochondral autograft transplantation.
        J Knee Surg. 2018; 31: 231-238
        • Cole B.J.
        • Pascual-Garrido C.
        • Grumet R.C.
        Surgical management of articular cartilage defects in the knee.
        J Bone Joint Surg Am. 2009; 91: 1778-1790
        • Frank R.M.
        • Cotter E.J.
        • Strauss E.J.
        • Gomoll A.H.
        • Cole B.J.
        The utility of biologics, osteotomy, and cartilage restoration in the knee.
        J Am Acad Orthop Surg. 2018; 26: e11-e25
        • Moran C.J.
        • Pascual-Garrido C.
        • Chubinskaya S.
        • et al.
        Restoration of articular cartilage.
        J Bone Joint Surg Am. 2014; 96: 336-344
        • Mitchell J.
        • Magnussen R.A.
        • Collins C.L.
        • et al.
        Epidemiology of patellofemoral instability injuries among high school athletes in the United States.
        Am J Sports Med. 2015; 43: 1676-1682
        • Brophy R.H.
        • Haas A.K.
        • Huston L.J.
        • Nwosu S.K.
        • Wright R.W.
        Association of meniscal status, lower extremity alignment, and body mass index with chondrosis at revision anterior cruciate ligament reconstruction.
        Am J Sports Med. 2015; 43: 1616-1622
        • Wyatt R.W.B.
        • Inacio M.C.S.
        • Liddle K.D.
        • Maletis G.B.
        Prevalence and incidence of cartilage injuries and meniscus tears in patients who underwent both primary and revision anterior cruciate ligament reconstructions.
        Am J Sports Med. 2014; 42: 1841-1846
        • Ghomrawi H.M.
        • Eggman A.A.
        • Pearle A.D.
        Effect of age on cost-effectiveness of unicompartmental knee arthroplasty compared with total knee arthroplasty in the U.S.
        J Bone Joint Surg Am. 2015; 97: 396-402
        • Khuri S.F.
        The NSQIP: A new frontier in surgery.
        Surgery. 2005; 138: 837-843
        • Osborne N.H.
        • Nicholas L.H.
        • Ryan A.M.
        • Thumma J.R.
        • Dimick J.B.
        Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries.
        JAMA. 2015; 313: 496-504
        • Molina C.S.
        • Thakore R.V.
        • Blumer A.
        • Obremskey W.T.
        • Sethi M.K.
        Use of the National Surgical Quality Improvement Program in orthopaedic surgery.
        Clin Orthop Relat Res. 2015; 473: 1574-1581
        • Bohl D.D.
        • Ondeck N.
        • Darrith B.
        • Hannon C.P.
        • Fillingham Y.A.
        • Della Valle C.J.
        Impact of operative time on adverse events following primary total joint arthroplasty.
        J Arthroplasty. 2018; 33: 2256-2262.e4
        • Frank R.M.
        • Lee S.
        • Levy D.
        • et al.
        Osteochondral allograft transplantation of the knee: Analysis of failures at 5 years.
        Am J Sports Med. 2017; 45: 864-874
        • Assenmacher A.T.
        • Pareek A.
        • Reardon P.J.
        • Macalena J.A.
        • Stuart M.J.
        • Krych A.J.
        Long-term outcomes after osteochondral allograft: A systematic review at long-term follow-up of 12.3 years.
        Arthroscopy. 2016; 32: 2160-2168
        • Pareek A.
        • Carey J.L.
        • Reardon P.J.
        • Peterson L.
        • Stuart M.J.
        • Krych A.J.
        Long-term outcomes after autologous chondrocyte implantation: A systematic review at mean follow-up of 11.4 years.
        Cartilage. 2016; 7: 298-308
        • Solheim E.
        • Hegna J.
        • Strand T.
        • Harlem T.
        • Inderhaug E.
        Randomized study of long-term (15-17 years) outcome after microfracture versus mosaicplasty in knee articular cartilage defects.
        Am J Sports Med. 2018; 46: 826-831
        • McCormick F.
        • Harris J.D.
        • Abrams G.D.
        • et al.
        Trends in the surgical treatment of articular cartilage lesions in the United States: An analysis of a large private-payer database over a period of 8 years.
        Arthroscopy. 2014; 30: 222-226
        • Montgomery S.R.
        • Foster B.D.
        • Ngo S.S.
        • et al.
        Trends in the surgical treatment of articular cartilage defects of the knee in the United States.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 2070-2075
      1. Hancock KJ, Westermann RR, Shamrock AG, Duchman KR, Wolf BR, Amendola A. Trends in knee articular cartilage treatments: An American Board of Orthopaedic Surgery database study [published online February 28, 2018]. J Knee Surg. doi:10.1055/s-0038-1635110.

        • Shelbourne K.D.
        • Jari S.
        • Gray T.
        Outcome of untreated traumatic articular cartilage defects of the knee: A natural history study.
        J Bone Joint Surg Am. 2003; 85: 8-16
        • Widuchowski W.
        • Widuchowski J.
        • Koczy B.
        • Szyluk K.
        Untreated asymptomatic deep cartilage lesions associated with anterior cruciate ligament injury: Results at 10- and 15-year follow-up.
        Am J Sports Med. 2009; 37: 688-692
        • Steadman J.R.
        • Briggs K.K.
        • Rodrigo J.J.
        • Kocher M.S.
        • Gill T.J.
        • Rodkey W.G.
        Outcomes of microfracture for traumatic chondral defects of the knee: Average 11-year follow-up.
        Arthroscopy. 2003; 19: 477-484
        • Nho S.J.
        • Pensak M.J.
        • Seigerman D.A.
        • Cole B.J.
        Rehabilitation after autologous chondrocyte implantation in athletes.
        Clin Sports Med. 2010; 29: 267-282, viii
        • Chahla J.
        • Cinque M.E.
        • Godin J.A.
        • et al.
        Meniscectomy and resultant articular cartilage lesions of the knee among prospective National Football League players: An imaging and performance analysis.
        Am J Sports Med. 2018; 46: 200-207
        • Haviv B.
        • Bronak S.
        • Kosashvili Y.
        • Thein R.
        Which patients are less likely to improve during the first year after arthroscopic partial meniscectomy? A multivariate analysis of 201 patients with prospective follow-up.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1427-1431
        • Bisson L.J.
        • Kluczynski M.A.
        • Wind W.M.
        • et al.
        Patient outcomes after observation versus debridement of unstable chondral lesions during partial meniscectomy: The Chondral Lesions and Meniscus Procedures (ChAMP) randomized controlled trial.
        J Bone Joint Surg Am. 2017; 99: 1078-1085
        • Anderson D.E.
        • Rose M.B.
        • Wille A.J.
        • Wiedrick J.
        • Crawford D.C.
        Arthroscopic mechanical chondroplasty of the knee is beneficial for treatment of focal cartilage lesions in the absence of concurrent pathology.
        Orthop J Sports Med. 2017; 5 (2325967117707213)
        • Loken S.
        • Heir S.
        • Holme I.
        • Engebretsen L.
        • Aroen A.
        6-year follow-up of 84 patients with cartilage defects in the knee. Knee scores improved but recovery was incomplete.
        Acta Orthop. 2010; 81: 611-618
        • Scillia A.J.
        • Aune K.T.
        • Andrachuk J.S.
        • et al.
        Return to play after chondroplasty of the knee in National Football League athletes.
        Am J Sports Med. 2015; 43: 663-668
        • Lee J.J.
        • Lee S.J.
        • Lee T.J.
        • Yoon T.H.
        • Choi C.H.
        Results of microfracture in the osteoarthritic knee with focal full-thickness articular cartilage defects and concomitant medial meniscal tears.
        Knee Surg Relat Res. 2013; 25: 71-76
        • Sharma L.
        • Eckstein F.
        • Song J.
        • et al.
        Relationship of meniscal damage, meniscal extrusion, malalignment, and joint laxity to subsequent cartilage loss in osteoarthritic knees.
        Arthritis Rheum. 2008; 58: 1716-1726
        • Mahmoud A.
        • Young J.
        • Bullock-Saxton J.
        • Myers P.
        Meniscal allograft transplantation: The effect of cartilage status on survivorship and clinical outcome.
        Arthroscopy. 2018; 34: 1871-1876.e1
        • Harris J.D.
        • Hussey K.
        • Saltzman B.M.
        • et al.
        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.
        Orthop J Sports Med. 2014; 2 (2325967114551528)
        • Chahal J.
        • Gross A.E.
        • Gross C.
        • et al.
        Outcomes of osteochondral allograft transplantation in the knee.
        Arthroscopy. 2013; 29: 575-588
        • Harris J.D.
        • Siston R.A.
        • Pan X.
        • Flanigan D.C.
        Autologous chondrocyte implantation: A systematic review.
        J Bone Joint Surg Am. 2010; 92: 2220-2233
        • Vasiliadis H.S.
        • Wasiak J.
        • Salanti G.
        Autologous chondrocyte implantation for the treatment of cartilage lesions of the knee: A systematic review of randomized studies.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1645-1655
        • Malinin T.I.
        • Mnaymneh W.
        • Lo H.K.
        • Hinkle D.K.
        Cryopreservation of articular cartilage. Ultrastructural observations and long-term results of experimental distal femoral transplantation.
        Clin Orthop Relat Res. 1994; 303: 18-32
        • Lee B.-S.
        • Kim H.-J.
        • Lee C.-R.
        • et al.
        Clinical outcomes of meniscal allograft transplantation with or without other procedures: A systematic review and meta-analysis.
        Am J Sports Med. 2017; (363546517726963)
        • Hangody L.
        • Vasarhelyi G.
        • Hangody L.R.
        • et al.
        Autologous osteochondral grafting—Technique and long-term results.
        Injury. 2008; 39: S32-S39
        • Braun S.
        • Minzlaff P.
        • Hollweck R.
        • Wortler K.
        • Imhoff A.B.
        The 5.5-year results of MegaOATS—Autologous transfer of the posterior femoral condyle: A case-series study.
        Arthritis Res Ther. 2008; 10: R68
        • Lim H.-C.
        • Bae J.-H.
        • Song S.-H.
        • Park Y.-E.
        • Kim S.-J.
        Current treatments of isolated articular cartilage lesions of the knee achieve similar outcomes.
        Clin Orthop Relat Res. 2012; 470: 2261-2267
        • Mundi R.
        • Bedi A.
        • Chow L.
        • et al.
        Cartilage restoration of the knee: A systematic review and meta-analysis of level 1 studies.
        Am J Sports Med. 2016; 44: 1888-1895
        • Negrin L.L.
        • Vecsei V.
        Do meta-analyses reveal time-dependent differences between the clinical outcomes achieved by microfracture and autologous chondrocyte implantation in the treatment of cartilage defects of the knee?.
        J Orthop Sci. 2013; 18: 940-948
        • Minas T.
        • Gomoll A.H.
        • Rosenberger R.
        • Royce R.O.
        • Bryant T.
        Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques.
        Am J Sports Med. 2009; 37: 902-908

      Linked Article

      • Editorial Commentary: When Performing Cartilage Restoration, Please Don't Put Down the Osteotomy Saw!
        ArthroscopyVol. 35Issue 1
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          Cartilage restoration procedures appear to be increasing in popularity and are being performed more frequently for older patients according to a recent analysis of database data. Chondroplasty and microfracture are most commonly performed; however, chondrocyte transfer procedures, including osteochondral autologous transplantation and autologous chondrocyte implantation, are being performed more commonly. Relatively few corrective osteotomies are being performed in conjunction with these procedures; this is concerning because surgeons are either not looking for malalignment or not correcting it.
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