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Cartilage Restoration Surgery: Incidence Rates, Complications, and Trends as Reported by the American Board of Orthopaedic Surgery Part II Candidates

      Purpose

      To evaluate the current status of advanced cartilage restoration procedures among newly trained orthopaedic surgeons in the United States.

      Methods

      The American Board of Orthopaedic Surgery database was queried to identify all advanced cartilage restoration procedure cases submitted by American Board of Orthopaedic Surgery part II board certification examination candidates from 2003 to 2015. All documented autologous chondrocyte implantation, autologous osteochondral transfer, osteochondral allograft transplantation, and marrow stimulation techniques (MSTs) procedures were analyzed. Analysis was performed to describe trends in annual incidence, types of complications, concomitant procedures, and geographical differences in incidence of advanced cartilage procedures.

      Results

      From 2003 to 2015, a total of 2,827 surgeons submitted 7,522 cartilage restoration procedures, with 7,060 cases documented as MST (80.01%). The number of cartilage cases decreased significantly from 2003 to in 2015 (P < .001), with MST having the largest decline (P < .001). The incidence of open osteochondral allograft transplantation (odds ratio = 1.35; P = .023) and open autologous osteochondral transfer (odds ratio = 0.84; P = .004) increased over the study period. Overall, the majority of patients (57.0%) were male; however, female patients were on average significantly older than male patients (P < .001). Cartilage procedures were performed concomitantly with a realignment osteotomy procedure in 1.7% of cases. The incidence of surgical complications increased throughout the study period from 2.9% in 2003 to 9.5% in 2015 (P < .001).

      Conclusions

      Cartilage restoration procedures, specifically MSTs, are being decreasingly performed among recently trained orthopaedic surgeons. In contrast, complication rates have been increasing since 2003, demonstrating a possible paradigm shift toward more complex cartilage procedures, specifically osteochondral grafting procedures.

      Clinical Relevance

      This study demonstrates a significant decline in the use of MSTs by recently trained orthopaedic surgeons. In addition, an increase in several more complex cartilage restoration procedures was found. Taken in sum, these changes may reflect a shift in residency and fellowship training away from marrow stimulation procedures that elicit a fibrocartilage reparative tissue and toward more complex procedures that provide a more hyaline-like articular cartilage surface.
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      Linked Article

      • Editorial Commentary: Trends in Cartilage Surgery—Who Is Steering the Ship?
        ArthroscopyVol. 35Issue 1
        • Preview
          With myriad cartilage surgery techniques available, including marrow stimulation, autologous osteochondral transfer, osteochondral allograft transplantation, and autologous chondrocyte implantation, treatment of knee articular cartilage injuries has become increasingly complex. Recent evidence suggests that advanced cartilage restoration procedures may provide improved outcomes and durability when compared with marrow stimulation techniques. When investigating orthopaedic surgeons early in practice, it appears that utilization of marrow stimulation techniques has decreased, an encouraging trend that is in line with recent evidence.
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