Trends in Knee Articular Cartilage Treatments: An American Board of Orthopaedic Surgery Database Study.

Abstract

This study aims to evaluate the trends in treatment of knee articular cartilage lesions over the past decade using data obtained from the American Board of Orthopaedic Surgery (ABOS) Part II database. The ABOS Part II database was queried from 2004 to 2013 for chondroplasty, microfracture, and osteochondral grafting procedures. All cases were analyzed for patient age and operating surgeon's fellowship training status. Univariate analysis including chi-square test for categorical variables and Student's t-test for continuous variables was performed to determine if any significant changes in practice patterns were present. Linear regression analyses were utilized to examine temporal trends in procedures performed and fellowship training status. From 2004 to 2013, 25,938 procedures addressing articular cartilage lesions from 3,586 surgeons were identified in the ABOS database. 46.8% of these orthopaedic surgeons had completed a 1-year sports medicine fellowship. Sixty-six percent of cartilage surgeries were performed by sports medicine-trained surgeons. The articular cartilage surgical volume decreased from 3,126 cases in 2004 to 1,690 cases in 2013. The most common procedure coded overall was chondroplasty (80.23%) followed by microfracture (21.37%) and osteochondral grafting (2.1%). The mean age of patients undergoing chondroplasty was 46.9 years; this was significantly higher than microfracture (mean age 40.5 years) or osteochondral grafting procedures (mean age 31.6 years), p < 0.0005. The age of all patients undergoing cartilage surgery significantly decreased between 2004 and 2013, p < 0.001. A dramatic decrease in reported chondroplasty volume was observed between 2011 and 2012. Concurrent osteotomies were used in <1% of procedures addressing cartilage injuries, while 65% of patients underwent concurrent meniscectomy. These described trends are most pronounced in surgeons with sports medicine fellowship training. In conclusion, knee articular cartilage surgical volume and patient age have both sharply declined since 2011, a trend driven by sports medicine-trained Part II examinees. This trend correlates with changes in billing and coding practices, as well as improved education from high-level studies.