Download PDF
J Knee Surg 2022; 35(02): 145-149
DOI: 10.1055/s-0040-1713126
Original Article

The Importance of Staging Arthroscopy for Chondral Defects of the Knee

Hytham S. Salem
1   Rothman Orthopedic Institute, Philadelphia, Pennsylvania
,
Zaira S. Chaudhry
1   Rothman Orthopedic Institute, Philadelphia, Pennsylvania
,
Ludovico Lucenti
2   Department of Orthopedic Surgery, University of Catania, Catania, Sicilia, Italy
,
Bradford S. Tucker
1   Rothman Orthopedic Institute, Philadelphia, Pennsylvania
,
Kevin B. Freedman
1   Rothman Orthopedic Institute, Philadelphia, Pennsylvania
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

This study aims to evaluate the role of staging arthroscopy in the diagnosis of knee chondral defects and subsequent surgical planning prior to autologous chondrocyte implantation (ACI), osteochondral allograft transplantation (OCA), and meniscus allograft transplantation (MAT). All patients who underwent staging arthroscopy prior to ACI, OCA, or MAT at our institution from 2005 to 2015 were identified. Medical records were reviewed to document the diagnosis and treatment plan based on symptoms, magnetic resonance imaging (MRI) findings and previous operative records. Operative records of the subsequent staging arthroscopy procedure were reviewed to document the proposed treatment plan after arthroscopy. All changes in treatment plan following staging arthroscopy were recorded. Univariate analyses were performed to identify any significant predictors for likelihood to change. A total of 98 patients were included in our analysis. A change in surgical plan was made following arthroscopy in 36 patients (36.7%). Fourteen patients (14.3%) were found to have additional defects that warranted cartilage restoration surgery. In 15 patients (15.3%), at least one defect that was originally thought to warrant cartilage restoration surgery was found to be amenable to debridement alone. The surgical plan was changed from ACI to OCA in four cases (4.1%) and OCA to ACI in one case (1%). A previously proposed MAT was deemed unwarranted in one case (1%), and a planned meniscal repair was changed to MAT in another (1%). Patient age, sex, and the affected knee compartment were not predictors for a change in surgical plan. Body mass index (BMI) was significantly higher in patients who had a change in surgical plan (29.5 kg/m2) compared with those who did not (26.5 kg/m2). A change in surgical plan was more likely to occur for trochlear lesions (46.4%) compared with other articular surface lesions (p = 0.008). The results of our study indicate that staging arthroscopy is an important step in determining the most appropriate treatment plan for chondral defects and meniscal deficiency, particularly those with trochlear cartilage lesions.

Keywords

knee - cartilage - arthroscopy - cartilage restoration surgery - surgical planning


Publication History

Received: 23 February 2020

Accepted: 02 May 2020

Article published online:
16 June 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Arøen A, Løken S, Heir S. et al. Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med 2004; 32 (01) 211-215
    CrossrefPubMedGoogle Scholar
  • 2 Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 1997; 13 (04) 456-460
    CrossrefPubMedGoogle Scholar
  • 3 Flanigan DC, Harris JD, Trinh TQ, Siston RA, Brophy RH. Prevalence of chondral defects in athletes' knees: a systematic review. Med Sci Sports Exerc 2010; 42 (10) 1795-1801
    CrossrefPubMedGoogle Scholar
  • 4 Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 2002; 18 (07) 730-734
    CrossrefPubMedGoogle Scholar
  • 5 Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: study of 25,124 knee arthroscopies. Knee 2007; 14 (03) 177-182
    CrossrefPubMedGoogle Scholar
  • 6 DePalma AF, McKeever CD, Subin DK. Process of repair of articular cartilage demonstrated by histology and autoradiography with tritiated thymidine. Clin Orthop Relat Res 1966; 48 (48) 229-242
    PubMedGoogle Scholar
  • 7 Cameron JI, Pulido PA, McCauley JC, Bugbee WD. Osteochondral allograft transplantation of the femoral trochlea. Am J Sports Med 2016; 44 (03) 633-638
    CrossrefPubMedGoogle Scholar
  • 8 Pareek A, Carey JL, Reardon PJ, Peterson L, Stuart MJ, Krych AJ. Long-term outcomes after autologous chondrocyte implantation: a systematic review at mean follow-up of 11.4 years. Cartilage 2016; 7 (04) 298-308
    CrossrefPubMedGoogle Scholar
  • 9 Pascual-Garrido C, Slabaugh MA, L'Heureux DR, Friel NA, Cole BJ. Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: prospective evaluation at average 4-year follow-up. Am J Sports Med 2009; 37 (Suppl. 01) 33S-41S
    CrossrefPubMedGoogle Scholar
  • 10 Torga Spak R, Teitge RA. Fresh osteochondral allografts for patellofemoral arthritis: long-term followup. Clin Orthop Relat Res 2006; 444 (444) 193-200
    CrossrefPubMedGoogle Scholar
  • 11 Trinh TQ, Harris JD, Siston RA, Flanigan DC. Improved outcomes with combined autologous chondrocyte implantation and patellofemoral osteotomy versus isolated autologous chondrocyte implantation. Arthroscopy 2013; 29 (03) 566-574
    CrossrefPubMedGoogle Scholar
  • 12 Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med 1986; 14 (04) 270-275
    CrossrefPubMedGoogle Scholar
  • 13 Paletta Jr GA, Manning T, Snell E, Parker R, Bergfeld J. The effect of allograft meniscal replacement on intraarticular contact area and pressures in the human knee. A biomechanical study. Am J Sports Med 1997; 25 (05) 692-698
    CrossrefPubMedGoogle Scholar
  • 14 Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br 1948; 30B (04) 664-670
    CrossrefPubMedGoogle Scholar
  • 15 Alford JW, Lewis P, Kang RW, Cole BJ. Rapid progression of chondral disease in the lateral compartment of the knee following meniscectomy. Arthroscopy 2005; 21 (12) 1505-1509
    CrossrefPubMedGoogle Scholar
  • 16 Allen PR, Denham RA, Swan AV. Late degenerative changes after meniscectomy. Factors affecting the knee after operation. J Bone Joint Surg Br 1984; 66 (05) 666-671
    CrossrefPubMedGoogle Scholar
  • 17 Jørgensen U, Sonne-Holm S, Lauridsen F, Rosenklint A. Long-term follow-up of meniscectomy in athletes. A prospective longitudinal study. J Bone Joint Surg Br 1987; 69 (01) 80-83
    CrossrefPubMedGoogle Scholar
  • 18 Myers P, Tudor F. Meniscal allograft transplantation: how should we be doing it? A systematic review. Arthroscopy 2015; 31 (05) 911-925
    CrossrefPubMedGoogle Scholar
  • 19 Hutchinson ID, Moran CJ, Potter HG, Warren RF, Rodeo SA. Restoration of the meniscus: form and function. Am J Sports Med 2014; 42 (04) 987-998
    CrossrefPubMedGoogle Scholar
  • 20 Outerbridge RE, Dunlop JA. The problem of chondromalacia patellae. Clin Orthop Relat Res 1975; (110) 177-196
    CrossrefPubMedGoogle Scholar
  • 21 Quatman CE, Hettrich CM, Schmitt LC, Spindler KP. The clinical utility and diagnostic performance of magnetic resonance imaging for identification of early and advanced knee osteoarthritis: a systematic review. Am J Sports Med 2011; 39 (07) 1557-1568
    CrossrefPubMedGoogle Scholar
  • 22 Nikolaou VS, Chronopoulos E, Savvidou C. et al. MRI efficacy in diagnosing internal lesions of the knee: a retrospective analysis. J Trauma Manag Outcomes 2008; 2 (01) 4
    CrossrefPubMedGoogle Scholar
  • 23 Zhang M, Min Z, Rana N, Liu H. Accuracy of magnetic resonance imaging in grading knee chondral defects. Arthroscopy 2013; 29 (02) 349-356
    CrossrefPubMedGoogle Scholar
  • 24 von Engelhardt LV, Lahner M, Klussmann A. et al. Arthroscopy vs. MRI for a detailed assessment of cartilage disease in osteoarthritis: diagnostic value of MRI in clinical practice. BMC Musculoskelet Disord 2010; 11: 75
    CrossrefPubMedGoogle Scholar