The Importance of Staging Arthroscopy for Chondral Defects of the Knee

Abstract

Objectives: Chondral injures of the knee are a common source of pain in athletes. The specificity and sensitivity of MRI in evaluating chondral defects of the knee have been found to be as low as 73% and 42%, respectively. Staging arthroscopy is a more accurate method of evaluating the articular surfaces of the knee prior to cartilage restoration surgery or meniscal allograft transplantation (MAT). Addressing all concomitant pathology can be important for the success of cartilage restoration surgery, and treatment plan may change based on the extent and location of cartilage damage. The purpose of this study is to evaluate the role of staging arthroscopy in the diagnosis of chondral defects prior to autologous chondrocyte implantation (ACI), osteochondral allograft transplantation (OCA) and MAT, and to elucidate its utility in surgical planning prior to these procedures. Methods: All patients who have undergone ACI, OCA or MAT of the knee with prior staging arthroscopy at our institution between January 2005 and May 2015 were included in our review. Cases in which defects were evaluated during another procedure, such as anterior cruciate ligament reconstruction or treatment of meniscal pathology, were excluded. Any patients who did not have a documented staging arthroscopy procedure were also excluded. Medical records were reviewed to document the diagnosis and treatment plan based on symptoms, MRI findings and previous operative records. Operative records of the subsequent staging arthroscopy procedure were then reviewed to document the number of chondral defects with corresponding size and grade, any concomitant meniscal pathology, and the proposed treatment plan after arthroscopic visualization of the knee. All changes in treatment plan following staging arthroscopy were recorded. Results: A total of 98 patients were included in our review with 52 females and 46 males. The mean age of our patient population was 32.3 (range 15.3-57.9), and the mean BMI was 27.58 (range 15.8-41.6). The primary diagnosis was articular cartilage pathology in 86 cases (87.8%) and meniscal deficiency in 12 cases (12.2%). A total of 46 patients (47%) had a change in plan following staging arthroscopy. Fourteen patients (14.3%) were found to have additional defects that warranted cartilage restoration surgery. Thirteen patients (13.3%) were found to have defects that did not warrant cartilage restoration surgery, and instead were managed with debridement chondroplasty. Surgical plan was changed from ACI to OCA in 4 cases (4.1%) and OCA to ACI in 1 case (1%). A previously proposed plan of MAT was deemed unwarranted in 1 case (1%), and an initial plan of meniscal repair was changed to MAT in another (1%). In 19 cases (19.4%), staging arthroscopy was used to determine whether OCA or ACI was most appropriate. Of these, 8 (42.1%) were treated with OCA, 8 (42.1%) underwent ACI, 1 (5.3%) received minced juvenile cartilage allograft transplant, and 2 (10.5%) had debridement chondroplasty alone. Conclusion: To our knowledge, this is the first study to provide empirical evidence on the clinical value of staging arthroscopy prior to ACI, OCA and MAT. Based on our review, a change in treatment plan was made in 47% of cases in which staging arthroscopy was used to evaluate articular cartilage surfaces. Therefore, the results of our study indicate that staging arthroscopy is an important step in determining the most appropriate treatment plan for chondral defects prior to OCA, ACI and MAT.