Ten-Year Follow-up of a Prospective, Randomized Clinical
Study of Mosaic Osteochondral Autologous Transplantation Versus Microfracture
for the Treatment of Osteochondral Defects in the Knee Joint of Athletes
Study of Mosaic Osteochondral Autologous Transplantation Versus Microfracture
for the Treatment of Osteochondral Defects in the Knee Joint of Athletes
Gudas
R, Gudaite A, Pocius A, Gudiene A, Cekanauskas E, Monastyreckiene E, &
R, Gudaite A, Pocius A, Gudiene A, Cekanauskas E, Monastyreckiene E, &
Basevicius A. American Journal of Sports Medicine. 40: 2499
– . DOI:10.1177/0363546512458763
– . DOI:10.1177/0363546512458763
Osteo-
and articular- chondral defects are becoming more common problems in the
athletic population. While there are
many options available to treat these defects, it still remains unclear which
is the best option, specifically in the long-term. Therefore, the purpose of this prospective
randomized study was to compare the 10 year outcomes between defects repaired
with a microfracture procedure
versus those repaired with an osteochondral autologous transplantation (OAT). Fifty-seven
patients met inclusion criteria (i.e., no evidence of chondromalacia,
osteoarthritis, concomitant meniscal injury, or malalignment; not overweight;
lesion < 4cm2; and age < 41 years old), were randomized to a
surgical group, and attended follow-up approximately 10 years
post-surgery. Patients were reevaluated
approximately 10 years post-surgery.
Cartilage integrity was analyzed using magnetic resonance imaging as
well as International Cartilage Repair Society outcome scores and Tegner scales
were used to assess activity levels, and osteoarthritis severity was assessed
using radiographs. All of these outcomes
were assessed pre-surgery as well as 10 years post-surgery. Overall, the OAT procedure resulted in better
clinical outcomes, including less failures (e.g., pain resulting in another
surgery), lower incidence of osteoarthritis, and higher activity levels compared to the group that received the microfracture procedure. Subanalyses of defect type (articular- or osteochondral in nature) revealed that articular defects have superior outcomes compared to
osteochondral defects. Lastly, activity levels
decreased across all defect types, as well as surgical type, but was
significantly decreased when the defect was larger in size (> 2 cm2).
and articular- chondral defects are becoming more common problems in the
athletic population. While there are
many options available to treat these defects, it still remains unclear which
is the best option, specifically in the long-term. Therefore, the purpose of this prospective
randomized study was to compare the 10 year outcomes between defects repaired
with a microfracture procedure
versus those repaired with an osteochondral autologous transplantation (OAT). Fifty-seven
patients met inclusion criteria (i.e., no evidence of chondromalacia,
osteoarthritis, concomitant meniscal injury, or malalignment; not overweight;
lesion < 4cm2; and age < 41 years old), were randomized to a
surgical group, and attended follow-up approximately 10 years
post-surgery. Patients were reevaluated
approximately 10 years post-surgery.
Cartilage integrity was analyzed using magnetic resonance imaging as
well as International Cartilage Repair Society outcome scores and Tegner scales
were used to assess activity levels, and osteoarthritis severity was assessed
using radiographs. All of these outcomes
were assessed pre-surgery as well as 10 years post-surgery. Overall, the OAT procedure resulted in better
clinical outcomes, including less failures (e.g., pain resulting in another
surgery), lower incidence of osteoarthritis, and higher activity levels compared to the group that received the microfracture procedure. Subanalyses of defect type (articular- or osteochondral in nature) revealed that articular defects have superior outcomes compared to
osteochondral defects. Lastly, activity levels
decreased across all defect types, as well as surgical type, but was
significantly decreased when the defect was larger in size (> 2 cm2).
This
is the first apparent study to investigate surgical repair of cartilage defects
in a highly competitive athletic population.
Clinically, it appears that the OAT procedure has a superior outcome
when compared to the microfracture procedure. It is
interesting that this study investigated return to a high level of athletic competition. Some surgeons recommend not returning to athletics
following this type of surgery, and merely resuming a physically active life to
improve long term outcomes. It would be
of interest if the authors investigated osteoarthritis incidence or severity
when correlated with activity level post-surgery. It may be that those that returned to higher
levels of activity result in greater incidence of osteoarthritis. Furthermore, an articular-defect seems like
it is not as dire of an injury as a defect into the subchondral bone. It may be that these defects are entirely
separate injuries and should be treated differently based on this premise. It
is very interesting as to the inclusion/exclusion criteria of this study. This group looked at a very specific group of
athletes that needed to be active in a sport a minimum of 6 days per week. Could it be that this is “too much” activity
after an injury like this? These athletes
had no other concomitant ligamentous or meniscal injuries; I wonder what the
outcomes would be like for athletes that do have concomitant injury? Does
anyone have any experiences dealing with either of these types of defects or
surgeries?
is the first apparent study to investigate surgical repair of cartilage defects
in a highly competitive athletic population.
Clinically, it appears that the OAT procedure has a superior outcome
when compared to the microfracture procedure. It is
interesting that this study investigated return to a high level of athletic competition. Some surgeons recommend not returning to athletics
following this type of surgery, and merely resuming a physically active life to
improve long term outcomes. It would be
of interest if the authors investigated osteoarthritis incidence or severity
when correlated with activity level post-surgery. It may be that those that returned to higher
levels of activity result in greater incidence of osteoarthritis. Furthermore, an articular-defect seems like
it is not as dire of an injury as a defect into the subchondral bone. It may be that these defects are entirely
separate injuries and should be treated differently based on this premise. It
is very interesting as to the inclusion/exclusion criteria of this study. This group looked at a very specific group of
athletes that needed to be active in a sport a minimum of 6 days per week. Could it be that this is “too much” activity
after an injury like this? These athletes
had no other concomitant ligamentous or meniscal injuries; I wonder what the
outcomes would be like for athletes that do have concomitant injury? Does
anyone have any experiences dealing with either of these types of defects or
surgeries?
Written
by: Nicole Cattano
by: Nicole Cattano
Reviewed
by: Stephen Thomas
by: Stephen Thomas
Related
Posts:
Posts:
Gudas, R., Gudaite, A., Pocius, A., Gudiene, A., Cekanauskas, E., Monastyreckiene, E., & Basevicius, A. (2012). Ten-Year Follow-up of a Prospective, Randomized Clinical Study of Mosaic Osteochondral Autologous Transplantation Versus Microfracture for the Treatment of Osteochondral Defects in the Knee Joint of Athletes The American Journal of Sports Medicine, 40 (11), 2499-2508 DOI: 10.1177/0363546512458763
I have seen literature on the incidence of OA following ACL injury and reconstruction that included other mensical and condral injuries. They found that people with these injuries had an increased risk of developing OA earlier in life. So I agree it would be interesting to see more specific literature on surgery combinations that produce the best long term outcomes for patients especially in the athletic population. I also agree that it would be interesting to see what kind of activity level is optimal following these types of injuries. I think that with further research we can start to answer the question: are we providing the best care for our athletes in the long term or are we setting them up for poor long term outcomes by getting them back to play quickly?
Nate-I couldn't agree with you more. I think that this is going to require a little bit of a shift in the culture of the profession. And I think it is going to be very difficult to help athletes to see longer term. Surgery had advanced so much that it allows for earlier RTP, but I seriously question if this is right for the athlete's long term health. Thanks for your comment!