Purpose
To provide updated surgical trends of cartilage procedures differentiated by the classic
groups of palliative, repair, and restorative modalities.
Methods
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.
Results
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).
Conclusions
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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Article info
Publication history
Published online: November 22, 2018
Accepted:
July 31,
2018
Received:
March 26,
2018
Footnotes
See commentary on page 147
The authors report the following potential conflict of interest or source of funding: N.N.V. receives personal fees from Arthrex, Arthrosurface, Cymedica, DJ Orthopedics, Minivasive, Omeros, Orthospace, Ossur, Smith & Nephew, Athletico, ConMed Linvatec, Miomed, Mitek, and Vindico Medical-Orthopedics Hyperguide. A.B.Y. receives personal fees from Arthrex, JRF Ortho, and NuTech. B.J.C. receives personal fees from Aesculap/B. Braun, Aqua Boom, Arthrex, Athletico, Biomerix, DJ Orthopaedics, Elsevier Publishing, Flexion, Geistlich, Giteliscope, JRF Ortho, Medipost, Norvartis, Ossio, Regentis, Sanofi-Aventis, Saunders/Mosby-Elsevier, Smith & Nephew, Tornier, and Zimmer. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2018 Published by Elsevier on behalf of the Arthroscopy Association of North America
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- Editorial Commentary: When Performing Cartilage Restoration, Please Don't Put Down the Osteotomy Saw!ArthroscopyVol. 35Issue 1
- PreviewCartilage 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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