Comparative efficacy of osteochondral autologous transplantation and microfracture in the knee: an updated meta-analysis of randomized controlled trials

Knee Cartilage Injuries in Football Players: Clinical Outcomes and Return to Sport After Surgical Treatment: A Systematic Review of the Literature

OBJECTIVE

To systematically review the literature and analyze clinical outcomes and return-to-sport after surgical management of cartilage injuries in football players.

DESIGN

A systematic literature review was performed in August 2023 on PubMed, WebOfScience, and Cochrane Library to collect studies on surgical strategies for cartilage lesions in football players. Methodological quality and risk of bias were assessed with the modified Coleman Methodology score and RoB2 and RoBANS2 tools.

RESULTS

Fifteen studies on 409 football players (86% men, 14% women) were included: nine prospective and two retrospective case series, one randomized controlled trial, one prospective comparative study, one case report, and one survey. Bone marrow stimulation (BMS) techniques were the most documented. The lesion size influenced the treatment choice: debridement was used for small lesions (1.1 cm2), BMS, osteochondral autograft transplantation (OAT), matrix-assisted autologous chondrocytes transplantation (MACT), and scaffold-augmented BMS for small/mid-size lesions (2.2-3.0 cm2), and autologous chondrocytes implantation (ACI) for larger lesions (5.8 cm2). The surgical options yielded different results in terms of clinical outcome and return-to-sport, with fastest recovery for debridement and scaffold-augmented BMS. The current evidence is limited with large methodological quality variation (modified Coleman Methodology score 43.5/100) and a high risk of bias.

CONCLUSIONS

Decision-making in cartilage injuries seems to privilege early return-to-sport, making debridement and microfractures the most used techniques. The lesion size influences the treatment choice. However, the current evidence is limited. Further studies are needed to confirm these findings and establish a case-based approach to treat cartilage injuries in football players based on the specific patient and lesion characteristics and the treatments' potential in terms of both return-to-sport and long-term results.

LEVEL OF EVIDENCE

Systematic review, level IV.

Return to Play After Knee Articular Cartilage Restoration: Surgical Options, Rehabilitation Protocols, and Performance Outcomes

PURPOSE OF REVIEW

Numerous cartilage restoration techniques have proven to be effective in the treatment of articular cartilage defects. The ultimate goal of these procedures is to improve pain and function, thereby increasing the likelihood of a patient's return to physical activity. Postoperative rehabilitation is a key component for a successful and expedient return to activities. The purpose of this article is to review the current literature regarding common surgical options, rehabilitation protocols, and performance outcomes after operative treatment of articular cartilage defects.

RECENT FINDINGS

Studies have demonstrated improved short- to long-term outcomes in a majority of techniques. However, the clinical benefits of microfracture are short-lived, which has led to the use of alternative procedures. Rehabilitation protocols are not standardized, but emphasis has been placed on bracing, weightbearing, early continuous passive range of motion, and strengthening to improve function. There is growing evidence to suggest that accelerated rehabilitation after matrix-induced autologous chondrocyte implantation may result in superior outcomes compared to delayed rehabilitation. Overall, most techniques result in satisfactory rates of return to play, though existing comparative studies typically include patients with heterogeneous pathology, complicating effective synthesis of outcomes data. In appropriately selected patients, cartilage restoration procedures after articular cartilage injury result in favorable patient-reported clinical outcomes and high rates of return to play. While studies emphasize the critical role that rehabilitation plays with respect to outcomes after surgery, there are substantial inconsistencies in protocols across techniques.

Multiphasic scaffolds for the repair of osteochondral defects: Outcomes of preclinical studies

Osteochondral defects are caused by injury to both the articular cartilage and subchondral bone within skeletal joints. They can lead to irreversible joint damage and increase the risk of progression to osteoarthritis. Current treatments for osteochondral injuries are not curative and only target symptoms, highlighting the need for a tissue engineering solution. Scaffold-based approaches can be used to assist osteochondral tissue regeneration, where biomaterials tailored to the properties of cartilage and bone are used to restore the defect and minimise the risk of further joint degeneration. This review captures original research studies published since 2015, on multiphasic scaffolds used to treat osteochondral defects in animal models. These studies used an extensive range of biomaterials for scaffold fabrication, consisting mainly of natural and synthetic polymers. Different methods were used to create multiphasic scaffold designs, including by integrating or fabricating multiple layers, creating gradients, or through the addition of factors such as minerals, growth factors, and cells. The studies used a variety of animals to model osteochondral defects, where rabbits were the most commonly chosen and the vast majority of studies reported small rather than large animal models. The few available clinical studies reporting cell-free scaffolds have shown promising early-stage results in osteochondral repair, but long-term follow-up is necessary to demonstrate consistency in defect restoration. Overall, preclinical studies of multiphasic scaffolds show favourable results in simultaneously regenerating cartilage and bone in animal models of osteochondral defects, suggesting that biomaterials-based tissue engineering strategies may be a promising solution.

The "hump" a new arthroscopic phenomenon guiding for reliable therapy of osteochondritis dissecans of variable stability status

INTRODUCTION

Despite 150 years of research, there are currently no reliable morphological characteristics that can be used to differentiate between stable and unstable juvenile osteochondritis dissecans (JOCD) lesions in the knee joint. Arthroscopic probing is still the gold standard. In arthroscopic evaluation, a previously undescribed pattern of a cartilaginous convex elevation ("hump") was identified as a new feature and potential sign of JOCD in transition to instability. The aim of the study was to evaluate the clinical outcomes after surgical intervention (drilling) on the "hump".

MATERIALS AND METHODS

In a retrospective case series of sixteen patients with an arthroscopically detectable "hump", the analysis of clinical function scores (Lysholm, Tegner) and morphological MRI monitoring of radiological healing were performed. The assessment of lesion healing was based on pre- and postoperative MRI examinations. The "hump" was defined as an arthroscopically impressive protrusion of the femoral articular surface with a minimally softened, discolored, but intact cartilage margin that, is not mobile upon in the arthroscopic palpation hook test. The primary therapy of choice was drilling of all "humps".

RESULTS

The "hump" could be detected arthroscopically in 16 of 59 JOCD lesions. Specific MRI correlations with the "hump" or arthroscopic unstable lesions could not be detected. Not all "humps" showed signs of MRI-based healing after the drilling, and in some a dissection of the osteochondral flap occurred within the first postoperative year. As a result, secondary refixation became necessary.

CONCLUSION

In the present study, the "hump" was identified as an important differential diagnostic arthroscopic feature of an arthroscopically primarily stable JOCD lesion, potentially placing the lesion at risk of secondary loosening over time. Therefore, drilling alone may not be appropriate in the event of arthroscopic "hump" discovery, but additional fixation may be required to achieve the healing of the lesion.

LEVEL OF EVIDENCE

III.