What did the study look at?
One approach to cartilage damage in the knee (chondral lesions) is repair using the patient's own cartilage (autologous cartilage). In a single-stage approach, the cartilage is prepared and applied to the damaged area during the same operation, without a separate laboratory step. The aim was to systematically review the clinical literature on how effective single-stage autologous cartilage repair is.
How was it done?
This is a systematic review: the authors did not treat new patients but searched published studies. PubMed, Scopus, Web of Science and the Cochrane Library were searched, following the PRISMA guidelines, an international reporting standard for systematic reviews. The authors report the level of evidence as "systematic review, level IV".
What did it find?
- Twelve studies were identified; because some described overlapping patient groups, 9 were included in the analysis.
- Six studies used minced cartilage and three used enzymatically processed cartilage.
- Two author groups used only cartilage debrided from the rim of the lesion, while the others used healthy cartilage or a combination of healthy cartilage and rim cartilage.
- Scaffold augmentation was used in four studies and bone autograft augmentation in three.
- Average improvement in patient-reported outcomes ranged from 18.7 ± 5.3 to 30.0 ± 8.0 across the KOOS (Knee Injury and Osteoarthritis Outcome Score) subsections, was 24.3 ± 10.5 for the IKDC subjective score and 41.0 ± 10.0 for the Visual Analogue Scale for pain.
- Average follow-up ranged from 12 to 201 months across studies.
The authors' conclusion
The authors describe single-stage autologous cartilage repair as a promising technique with positive clinical data to date. They state that the study highlights both the overall improvement in patient-reported outcomes after repair of knee cartilage defects and the heterogeneity and variability of the single-stage technique. They call for discussion on standardising a cost-effective single-stage technique and for well-designed randomised controlled trials comparing it with established treatments.
Limitations
The main limitation highlighted in the abstract is that the techniques in the included studies differed considerably, so the results do not represent a single standard method. The authors also point to the lack of randomised controlled trials comparing this approach with established treatments. This summary is based on the published abstract, as the full text could not be accessed.
Reference
Dasari SP, Jawanda H, Mameri ES, Fortier LM, Polce EM, Kerzner B, Gürsoy S, Hevesi M, Khan ZA, Jackson GR, Cole BJ, Yanke AB, Verma NN, Chahla J. (2023). Single-stage autologous cartilage repair results in positive patient-reported outcomes for chondral lesions of the knee: a systematic review. Journal of ISAKOS, 8(5), 372–380. Licence: CC BY-NC-ND 4.0.
DOI: 10.1016/j.jisako.2023.05.003
Free full text: jisakos.com (PDF)
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
