Defining Failure After Cartilage Preservation Surgery: Are We Expecting Too Much?

Abstract

ABSTRACT As cartilage restoration procedures continue to be more widely performed, an associated increase in the number of patients who “fail” is inevitable. While the goal of preventing progression towards arthroplasty remains elusive, cartilage repair can delay the need for arthroplasty and improve pain and function in young and active patients, thus, at a minimum, serving as a bridging procedure. Although cartilage preservation procedures are perceived to result in high rates of failure, when examined in the context of other common orthopedic procedures such as total knee arthroplasty and anterior cruciate ligament reconstruction, the rates of unsatisfactory outcomes are relatively similar. Furthermore, despite criticism of high rates of failure after cartilage repair surgery, how this failure is defined remains rather ambiguous. Current definitions of failure often do not incorporate patient-specific outcome trajectories, and rarely consider clinically significant improvements relative to each patient's baseline level of function and goals. The purpose of the current review is to present both an objective understanding of how failure is currently defined and widely understood in the realm of cartilage repair surgery, as well as a discussion of the goals of cartilage repair, and potential definitions of success and failure of cartilage repair.