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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:https://doi.org/10.1016/j.arthro.2018.07.049

      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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      Linked Article

      • Editorial Commentary: When Performing Cartilage Restoration, Please Don't Put Down the Osteotomy Saw!
        ArthroscopyVol. 35Issue 1
        • Preview
          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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