Trends in Articular Cartilage Treatments of the Knee

Abstract

Objectives:Full-thickness articular cartilage defects of the knee are often encountered during arthroscopy. Management likely varies between surgeons and may include chondroplasty, microfracture, or osteochondral grafting procedures. The purpose of this study is to evaluate the trends in treatment of articular cartilage lesions over the past decade using data obtained from the ABOS database.Methods:The American Board of Orthopaedic Surgery part II database was queried from 2004 through 2013. Cases involving Common Procedural Terminology (CPT) codes representing chondroplasty (29877), microfracture (29879), and osteochondral grafting procedures (27415, 27416, 29866, 29867) were selected. Surgical cases were categorized by year and by surgeon and patient variables provided by the database. Surgeon-specific variables of interest will include determination of fellowship training status. Patient-specific variables of interest will include age. Univariate analysis including chi-square test for categorical variables and Student's t-test for continuous variables will be performed to determine any significant changes in practice patterns based on the location and year of the procedure as well as previously noted surgeon- and patient-specific variables. The level of significance will be set to p < 0.05.Results:Between 2004-2013, 27,707 procedures addressing articular cartilage lesions were identified in the ABOS database. Overall, the reported surgical volume for treatment of articular cartilage lesions of the knee has decreased from 3126 cases/year in 2004 to 1690 cases/year in 2013. The most common procedure performed overall was chondroplasty (76.0%) followed by microfracture (19.9%) and Osteochondral grafting procedures (4%). The mean age of patients undergoing chondroplasty was 46.9; this was significantly higher than microfracture (mean age 40.5) or Osteochondral grafting procedures (mean age 31.6), p<0.0005. The age of patients undergoing chondroplasty, microfracture and Osteochondral grafting procedures significantly decreased between 2004-2013 (p<0.0001). The volume of microfracture has gradually decreased over time. A sharp decrease in reported chondroplasty procedures was observed between 2011 and 2012, and that trend has continued. A sharp increase in the utilization of Osteochondral grafting was observed beginning in 2011 by fellowship trained sports medicine surgeons.Conclusion:The overall decrease in surgical volume for articular cartilage treatments of the knee appears to be driven by a sharp decline in the use of chondroplasty since 2011. The average age of patients undergoing procedures addressing articular cartilage defects is decreasing. The volume of osteochondral grafting procedures has remained steady, and may be increasing; this is most pronounced in surgeons with sports medicine fellowship training.