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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Article info
Publication history
Accepted:
August 8,
2018
Received:
March 11,
2018
Footnotes
See commentary on page 179
The authors report the following potential conflicts of interest or sources of funding: B.J.C receives support from Aesculap/B. Braun, Aqua Boon, Arthrex, Athletico, Biomerix, DJ Orthopaedics, Elsevier Publishing. Flexion, Geistlich, Giteliscopy, JRF Ortho, Medipost, National Institutes of Health, Novartis, Operative Techniques in Sports Medicine, 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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Copyright
© 2018 by the Arthroscopy Association of North America
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Access this article on ScienceDirectLinked Article
- Editorial Commentary: Trends in Cartilage Surgery—Who Is Steering the Ship?ArthroscopyVol. 35Issue 1
- PreviewWith 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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