Articular Cartilage Lesions In Knee Research Articles

Proprioception and Mechanoreceptors in Osteoarthritis: A Systematic Literature Review.

Osteoarthritis (OA) is one of the most common chronic diseases in the world. It is frequently accompanied by high levels of persistent pain, as well as substantial impairments in function and functional capacity. This review aims to systematically analyze the changes in proprioception and related mechanoreceptors in OA patients. Studies from September 2013 to September 2023 were identified by conducting searches on the PubMed, Web of Science, and Scopus electronic databases following the PRISMA statement. One reviewer independently assessed and screened the literature, extracted the data, and graded the studies. The body of evidence underwent an evaluation and grading process using the ROBINS-I tool, which was specifically designed to assess the risk of bias in non-randomized studies of interventions. Results were summarized using descriptive methods. A search through 37 studies yielded 14 clinical studies that were ultimately included. The primary focus of the studies was on the knee joint, particularly the posterior cruciate ligament (PCL). The studies found that PCL in OA patients had impaired proprioceptive accuracy, possibly due to changes in mechanoreceptors (Ruffini, Pacini, and Golgi Mazzoni corpuscles). This suggests that dysfunctional articular mechanoreceptors, especially in severe cases of OA, may contribute to reduced proprioception. Dynamic stabilometry also identified significant proprioceptive deficits in patients with knee articular cartilage lesions, underscoring the impact of such lesions on knee proprioception. Literature data have shown that proprioceptive accuracy may play an important role in OA, particularly in the knee PCL and cartilage. However, the role of proprioception and related mechanoreceptors needs to be further clarified. Future studies focusing on the relationship between proprioception, OA disease, and symptoms, considering age and gender differences, and exploring OA joints other than the knee should be conducted to improve clinical and surgical outcomes in cases where proprioception and mechanoreceptors are impaired in OA patients.

Comparison of a Routine Magnetic Resonance Imaging & T2* Mapping of Articular Cartilage in Knee Osteoarthritis

Purpose To detect the knee articular cartilage lesions in T2* mapping as compared to a routine standard magnetic resonance imaging (MRI) at 3T. Material and Methods Twenty-five patients, complaining of knee pain and trauma, underwent knee MRI and were imaged with a standard knee MRI protocol (proton-density-weighted Fat Sat sagittal and axial series, T2weighted sagittal and axial series, and T1-weighted coronal series) and Proton density 3D sagittal and axial sequences are added, then images of T2* relaxation time is generated with color-coded mapping representing the relaxation time. The detected lesions were evaluated for lesion width (mm), lesion depth (1/3, 2/3, or 3/3 of cartilage thickness), and T2 values (20–40 ms, 40–60 ms, or 60– 80 ms). Results The study was conducted on 25 patients (13 female & 12 male with a mean of 44.92 ± 11.74 years). 87 lesions were detected both on MRI and T2 maps, while 41 lesions were visible only on T2* maps. The cartilage lesions’ width and depth measurements showed no statistically significant difference on T2 maps as compared to standard knee MRI. Many lesions (45) had moderately (T2 40–60 ms) increased T2 values, while 29 lesions had slightly (T2 20–40 ms) and 13 lesions with remarkably (T2 60– 80 ms) increased T2 relaxation times. Conclusion T2 mapping of articular cartilage is efficient in cartilage evaluation and may reveal early cartilage lesions not visible on standard clinical MRI.

Measuring Outcomes in Knee Articular Cartilage Pathology

Measuring outcomes following treatment of knee articular cartilage lesions is crucial to determine the natural history of disease and the efficacy of treatments. Outcome assessments for articular cartilage treatments can be clinical (based on failure, lack of healing, reoperation, need for arthroplasty), radiographic (X-ray, MRI), histologic, or patient reported and functional. The purpose of this review is to discuss the application and properties of patient-reported outcomes (PROs) with a focus on articular cartilage injuries and surgery in the knee. The most frequently used and validated PROs for knee articular cartilage studies include: the Knee injury and Osteoarthritis and Outcome Score, International Knee Documentation Committee Subjective Knee Form, and Lysholm score as knee-specific measures; the Marx Activity Rating Scale and Tegner Activity Scale as activity measures; and EQ-5D and SF-36/12 as generic quality-of-life measures. Incorporating these validated PROs in studies pertaining to knee articular cartilage lesions will allow researchers to fully capture clinically relevant outcomes that are most important to patients.

Post-traumatic Articular Cartilage Lesions Increase at Second-look Arthroscopy Following Primary Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament (ACL) reconstruction (ACLR) after ACL rupture improves the instability of the knee joint and decreases mechanical stress to the meniscus and articular cartilage. However, there are reports that post-traumatic osteoarthritis (PTOA) is observed over time following ACLR. In this study, we assessed changes in cartilage lesions by arthroscopic findings following anatomical double-bundle ACLR and at post-operative second-look arthroscopy about 14 months later. We retrospectively evaluated 37 knees in cases with patients <40 years of age who had undergone an anatomical double-bundle ACL reconstruction <1 year after ACL rupture injury from March 2012 to December 2016. Clinical results and arthroscopic cartilage/meniscal lesion were evaluated and compared between a cartilage lesion-detected group and intact-cartilage group. Surgery improved anteroposterior laxity and other clinical measures; however, cartilage lesions were detected at 11 sites during ACLR and at 54 sites at second-look arthroscopy. The periods from injury to second-look arthroscopy and from ACLR to second-look arthroscopy were significantly longer in the cartilage-lesion group (n=23) than in the intact-cartilage group (n=14). Conversely, 96% of meniscal damage observed during ACLR was cured at the time of second-look arthroscopy. Knee articular cartilage lesions after ACL rupture cannot be completely suppressed, even using the anatomical ACL reconstruction technique. This study suggested that articular cartilage lesions can progress to a level that can be confirmed arthroscopically at approximately 17 months after ACL injury. Therefore, in ACLR patients, the possibility of developing knee articular cartilage lesions and PTOA should be considered.

Osteochondral Autograft Transplant (Mosaicplasty) for Knee Articular Cartilage Defects.

Osteochondral autograft transplant (mosaicplasty) is a cartilage repair procedure for patients with knee articular cartilage lesions of a substantial size (>3 cm2). Patient selection is key to a successful result; patients with established osteoarthritis or systematic disorders such as rheumatoid arthritis should not undergo surgery. An exercise program involving neuromuscular training for a minimum of 3 months should be attempted before proceeding to osteochondral autograft transplant. The procedure can, in many cases, be performed arthroscopically. Patients should, however, provide consent for a mini-arthrotomy as this might be needed to achieve optimal access for graft harvesting and insertion. The procedure, in general, consists of 4 major steps. (1) At the initial arthroscopic examination, the size and localization of the defect are assessed after a proper debridement has been performed. The number and size of autografts needed can thereafter be assessed. (2) Graft harvesting is then performed from the periphery of the non-weight-bearing trochlea. (3) To prepare for graft insertion at the recipient site, a drill guide is inserted perpendicular to the joint surface in the defect to allow graft sockets to be reamed. (4) Grafts should be spaced approximately 3 mm apart to avoid confluence of tunnels and weakening of condyles. The orientation and depth of insertion of the grafts are key to mimic the native curvature of the affected joint surface. After an initial phase of non-weight-bearing focusing on range of motion, a gradual increase in neuromuscular exercises is recommended. Patients are typically advised to delay their return to sports until 6 months at the earliest. Results after mosaicplasty have shown that the procedure improves subjective outcomes, compared with baseline function, for up to 10 years after surgery. The additional effect over traditional microfracture treatment is, however, reduced over time. A study evaluating early factors affecting outcomes after cartilage repair procedures (including mosaicplasty) found that a series of factors, such as the time from the onset of symptoms to surgery, number and size of lesions, location and quality of surrounding cartilage, as well as concomitant meniscal injuries, were important3.

Functional Results of Different Repair Techniques for Knee Articular Cartilage Lesions

The articular cartilage lesions are frequent and highly affect the patient�s quality of life. Although remarkable progress in the treatment of focal lesions of articular cartilage were lately made, controversies still exist regarding the treatment options. The main purpose of this study was to evaluate and compare the preoperative and 6 months postoperative knee functional scores of patients undergoing arthroscopic repair of knee chondral lesions by: debridement, microfractures, osteochondral autograft transplantation and autologous matrix-induced chondrogenesis. Chondral reconstruction with collagen membranes and osteochondral autograft transplantation techniques showed a superior result at 6 months postoperatively compared to microfracture techniques and mechanical debridement.

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

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.

Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018: Using the Evidence to Guide Physical Therapist Practice.

Meniscus and articular cartilage lesions are common knee injuries. The resulting knee pain and mobility impairments can be improved by physical therapists during nonoperative and operative management. Recommendations from clinical practice guidelines (CPGs) such as this revision, titled "Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions," published in the February 2018 issue of JOSPT, can help physical therapists engage in evidence-informed practice and reduce unnecessary clinical variation. J Orthop Sports Phys Ther 2018;48(2):123-124. doi:10.2519/jospt.2018.0503.

Kelio sąnario kremzlės pažeidimų laipsnio ir dažnio priklausomybė nuo lyties, amžiaus ir dažniausiai pažeidžiamos sritys

Knee articular cartilage lesions are a common and relevant problem. Lesions are influenced by gender, age, race, genetic factors, obesity, trauma, previous inflammatory processes. Modern methods of treatment of osteoarthritis can‘t fully restore degene­ rated cartilage normal function, so it is very important to assess risk factors and identify lesions of cartilage in time and choose the most effective treatment to stop further cartilage degeneration. This study shows the knee articular cartilage lesions dependence on key risk factors: age, gender, most vulnerable cartilage areas and the prevailing degree of lesions and their incidence in different age groups who had knee arthroscopic operations. Results. The study included 1145 patients who had knee joint arthroscopic operations during which were rated knee cartilage le­sions degree and area according to the cartilage evaluation map and ICRS (International Cartilage Repair Society) form. The average age of studied patients was 45.97 ± 16.71. It was found that the knee articular cartilage defects were found in 65.0% of patients. No lesions were found in 35.0% of the patients. When men and women were compared according to whether lesions occur more frequently or which patient has more lesions p-value was calculated 0.05. During art­hroscopies 3770 lesions of different areas were found: men 37.3%, women 62.7%. Damaged areas distribution for both genders were: F1 2.9%, F2 1.4%, F3 13.6%, F4 13.4%, F5 5.6%, F6 5.4%, F7 0.2%, F8 0.3%, F9 2.1%, F10 2.0%, P1 2.3%, P2 2.4%, P3 8.9%, P4 9.0%, P5 1.9%, P6 1.9%, T1 3.0%, T2 0.5%, T3 1.0%, T4 8.1%, T5 7.5%, T6 0.3%, T7 0.1%, T8 0.0%, T9 3.1%, T10 3.1%. Patients were divided into seven age groups and it was found that for patients group under 25 years, various degree knee articular cartilage lesions were found in 28.5% of the knees and in 71.5% no lesions were found. For patients 25-35 years old lesions were found in 41.4% of the knees and in 58.6% cases no lesions were found. For patients 35-45 years old lesions were found in 57.9% of the knees and 42.1% no lesions were found. For patients 45-55 years old, lesions were found in 78.4% of the knees and 21.6% no lesions were found. For patients 55-65 years old lesions were found in 87.1% of the knees and 12.9% no lesions were found. For patients 65-75 years old lesions were found in 80.1% of the knees and 19.9% no lesions were found. For patients older than 75 years, lesions were found in 84.4% of the knees and 15.6% no lesions were found. For patients under 25 years I degree lesions were found in 29.6% of the cases, II degree – 56.8%, III degree – 7.4%, IV degree – 6.2%. For patients 25-35 years old, I degree lesions were found in 22.0% of the cases, II – 52.3%, III – 17.0% IV – 8.7%. For patients 35-45 years old, I degree lesions were found in 11.6% of the cases, II – 45.4%, III – 27.5% IV – 15.5%. For patients 45-55 years old, I degree lesions were found in 9.8% of the cases, II – 45.3%, III – 32.0% IV – 12.9%. For patients 55-65 years old, I degree lesions were found in 3.3% of cases, II – 44.4%, III – 37.9% IV – 14.4%. For patients 65-75 years old, I degree lesions were found in 6.9% of the cases, II – 36.0%, III – 33.8% IV – 23.3%. For older than 75 years patients I degree lesions were found in 3.9% of the cases, II – 30.5%, III – 35.1% IV – 30.5%. Spearman‘s rank correlation between the number of lesions of a particular patien t and the patient‘s age obtained p-value <0.05 shows that the correlation is statistically significant. Correlation 0.48 – strong, positive, showing that lesions were found in older people more frequently. Conclusions. Gender and age are a statistically significant fac­tors for knee articular cartilage lesion degree and frequency. Age affects the size of the lesion degree, the older the patient the greater the degree of damage was determined in the articular cartilage of the knee. From 45-55 years significantly increases the knee articular cartilage lesions quantity and degree of lesions. The most commonly damaged areas of the knee articular carti­lage were F3-F4 internal femoral condyle cartilage, P3-P4 patellar cartilage, T4-T5 internal tibial condyle cartilage.

MR imaging of articular cartilage at 1.5T and 3.0T: comparison of IDEAL 2D FSE and 3D SPGR with fat-saturated 2D FSE and 3D SPGR in a porcine model

IDEAL technique is a robust fat-water separation method which is potentially useful in cartilage imaging with significant improvement in the cartilage signal-to-noise ratio (SNR). To identify whether iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) improved diagnostic performance for IDEAL 2D fast spin echo (FSE) and 3D spoiled gradient-recalled echo (SPGR) versus fat-saturated (FS) protocols at 1.5 and 3.0 T in the evaluation of patella-femoral cartilage lesions. Forty-six artificial cartilage lesions were created in femoro-patellar articular cartilages of 11 porcine knees. All knees underwent MR examination at 1.5 and 3.0 T with MR protocol consisting of sagittal FS 2D FSE and 3D SPGR and IDEAL 2D FSE and IDEAL 3D SPGR, respectively. Qualitative assessment was performed to compare the diagnostic performance between 1.5- and 3.0-T protocols and between IDEAL and FS protocols. IDEAL 3D SPGR had a significantly higher accuracy for detecting partial thickness cartilage lesions (P < 0.01) than FS SPGR protocols, whereas there was no significant difference in diagnostic performance between IDEAL and FS 2D FSE except for one cartilage lesion. For all imaging sequences, no significant difference was observed in the diagnostic performance between 1.5- and 3.0-T imaging protocols (P = 0.42-0.91). Compared with conventional FS SPGR imaging, IDEAL 3D SPGR provided a better diagnostic performance for evaluation of porcine knee articular cartilage lesions in the knee joints at 1.5 and 3.0 T. IDEAL 3D SPGR may therefore be useful for detecting partial-thickness cartilage lesions in patients with degenerative osteoarthritis.

3.0-Tesla MRI and Arthroscopy for Assessment of Knee Articular Cartilage Lesions

The purpose of this study was to evaluate the ability of 3.0-Tesla magnetic resonance imaging (MRI) to accurately assess knee articular cartilage lesions. Sixteen patients who had knee 3.0-T MRI and underwent knee arthroscopy for partial meniscectomy were included. Three fellowship-trained sports medicine orthopedic surgeons reviewed all images. Articular lesions on MRI were graded from I to IV and compared with arthroscopic grading using the Outerbridge and the International Cartilage Repair Society (ICRS) classifications. The articular surface was divided into 6 regions. Based on MRI findings, of the 288 articular surface evaluations, 113 (39%) surface evaluations were classified as disease-positive (grade 2 to 4). Kappa interrater reliability scores for MRI evaluation, Outerbridge classification, and ICRS classification were 0.13, 0.54, and 0.41, respectively. Using the Outerbridge classification as a reference standard, the sensitivity, specificity, and accuracy were 57%, 71%, and 63%, respectively. Using the ICRS classification, sensitivity, specificity, and accuracy were 59%, 71%, and 69%, respectively. When isolating the articular grading to the senior author on MRI evaluation vs Outerbridge classification, the sensitivity, specificity, and accuracy were 54%, 92%, and 75%, respectively. Based on the current findings, 3.0-T MRI is as an invaluable noninvasive tool with good diagnostic value for assessing articular cartilage lesions of the knee, although it may not be as sensitive and accurate as previously reported.

Scientific Evidence Base for Cartilage Injury and Repair in the Athlete

Soccer players and athletes in high-impact sports are frequently affected by knee injuries. Injuries to the anterior cruciate ligament and menisci are frequently observed in soccer players and may increase the risk of developing an articular cartilage lesion. In high-level athletes, the overall prevalence of knee articular cartilage lesions has been reported to be 36% to 38%. The treatment for athletic patients with articular cartilage lesions is often challenging because of the high demands placed on the repair tissue by impact sports. Cartilage defects in athletes can be treated with microfracture, osteochondral grafting, and autologous chondrocyte implantation. There is increasing scientific evidence for cartilage repair in athletes, with more extensive information available for microfracture and autologous chondrocyte implantation than for osteochondral grafting. The reported rates and times to return to sport at the preinjury level are variable in recreational players, with the best results seen in younger and high-level athletes. Better return to sport is consistently observed for all repair techniques with early cartilage repair. Besides minimizing sensorimotor deficits and addressing accompanying pathologies, the quality of the repair tissue may be a significant factor for the return to sport.

Previous Knee Surgery Is a Risk Factor for Knee Articular Cartilage Lesions Among Athletes at the NFL Combine (SS-29)

Introduction Although articular cartilage lesions of the knee are a common finding among elite athletes, the risk factors for these lesions have not been well defined. The purpose of this study was to better define the prevalence of articular cartilage lesions in elite football players undergoing knee MRI at the National Football League (NFL) Combine and to test the hypothesis that previous knee surgery is a risk factor for these lesions. Methods We performed a retrospective review of all NFL Combine participants undergoing knee MRI from 2005 to 2009. A total of 597 players (726 knee MRIs) were reviewed for evidence of articular cartilage disease, classified as absent, chondromalacia, or full-thickness cartilage loss. History of previous knee surgery (including ACL reconstruction, meniscal procedures, and articular cartilage surgery) was recorded for each athlete. Results Full-thickness articular cartilage lesions were seen in 18% of knees and were associated with a history of any previous knee surgery (p<0.001) and specifically, previous meniscectomy (p<0.001). Full-thickness lesions were present in 29% of knees with a previous meniscectomy compared to 14% of knees without previous meniscal surgery (p<0.001). Full-thickness lesions were found in the lateral compartment of 25% of knees with previous partial lateral meniscectomy compared to 5% of knees without such surgery (p<0.001). The effect was also present in the medial compartment where 2% of knees without previous partial medial meniscectomy had full-thickness lesions compared to 7% of knees with previous partial medial meniscectomy (p=0.025). Previous ACL reconstruction was not associated with an increased risk of full-thickness articular cartilage lesions. Conclusion Previous knee surgery is a risk factor for full-thickness cartilage lesions in athletes participating in cutting contact sports such as American football. Partial meniscectomy increases the risk of full-thickness cartilage lesions, particularly in the lateral compartment. Future research should investigate the effect of these lesions on athlete performance and longevity, as well as potential methods of chondral protection such as meniscal repair in this patient cohort. Although articular cartilage lesions of the knee are a common finding among elite athletes, the risk factors for these lesions have not been well defined. The purpose of this study was to better define the prevalence of articular cartilage lesions in elite football players undergoing knee MRI at the National Football League (NFL) Combine and to test the hypothesis that previous knee surgery is a risk factor for these lesions. We performed a retrospective review of all NFL Combine participants undergoing knee MRI from 2005 to 2009. A total of 597 players (726 knee MRIs) were reviewed for evidence of articular cartilage disease, classified as absent, chondromalacia, or full-thickness cartilage loss. History of previous knee surgery (including ACL reconstruction, meniscal procedures, and articular cartilage surgery) was recorded for each athlete. Full-thickness articular cartilage lesions were seen in 18% of knees and were associated with a history of any previous knee surgery (p<0.001) and specifically, previous meniscectomy (p<0.001). Full-thickness lesions were present in 29% of knees with a previous meniscectomy compared to 14% of knees without previous meniscal surgery (p<0.001). Full-thickness lesions were found in the lateral compartment of 25% of knees with previous partial lateral meniscectomy compared to 5% of knees without such surgery (p<0.001). The effect was also present in the medial compartment where 2% of knees without previous partial medial meniscectomy had full-thickness lesions compared to 7% of knees with previous partial medial meniscectomy (p=0.025). Previous ACL reconstruction was not associated with an increased risk of full-thickness articular cartilage lesions. Previous knee surgery is a risk factor for full-thickness cartilage lesions in athletes participating in cutting contact sports such as American football. Partial meniscectomy increases the risk of full-thickness cartilage lesions, particularly in the lateral compartment. Future research should investigate the effect of these lesions on athlete performance and longevity, as well as potential methods of chondral protection such as meniscal repair in this patient cohort.

Prospective comparison of 3D FIESTA versus fat-suppressed 3D SPGR MRI in evaluating knee cartilage lesions

To prospectively compare the accuracy of three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) sequences with that of fat-suppressed three-dimensional spoiled gradient-recalled (3D SPGR) in the diagnosis of knee articular cartilage lesions, using arthroscopy as the reference standard. Fifty-eight knees in 54 patients (age range 21-82 years; mean 36 years) were prospectively evaluated by using sagittal 3D FIESTA and sagittal fat-suppressed 3D SPGR sequences. Articular cartilage lesions were graded on MRI and during arthroscopy with a modified Noyes scoring system. Sensitivity, specificity, and accuracy were assessed. Interobserver agreement was determined with kappa statistics. The performance of 3D FIESTA sequences (sensitivity, specificity, and accuracy were 80, 94, and 92%, respectively, for reader 1 and 76, 94, and 90%, respectively, for reader 2) was similar to that of fat-suppressed 3D SPGR sequences (sensitivity, specificity, and accuracy were 82, 92, and 90%, respectively, for reader 1 and 82, 90, and 88%, respectively, for reader 2) in the detection of knee articular cartilage lesions. The interobserver agreement varied from fair to good to excellent (kappa values from 0.43-0.83). 3D FIESTA has good diagnostic performance, comparable with fat-suppressed 3D SPGR in evaluating knee cartilage lesions, and it can be incorporated into routine knee MRI protocols due to the short acquisition time.

Articular cartilage defects: Study of 25,124 knee arthroscopies

This retrospective study aimed to provide data on the prevalence, epidemiology and etiology of the knee articular cartilage lesions and describe and estimate, on the ground of a large database, the number of patients who might benefit from cartilage repair surgery. The analysis of 25,124 knee arthroscopies performed from 1989 to 2004 was conducted. Information concerning cartilage lesion, associated articular lesions and performed procedure were collected. Cartilage lesions were classified in accordance with the Outerbridge classification. Chondral lesions were found in 60% of the patients. Documented cartilage lesions were classified as localized focal osteochondral or chondral lesion in 67%, osteoarthritis in 29%, osteochondritis dissecans in 2% and other types in 1%. Non-isolated cartilage lesions accounted for 70% and isolated lesions accounted for 30%. The patellar articular surface (36%) and the medial femoral condyle (34%) were the most frequent localization of the cartilage lesions. Grade II according to Outerbridge classification was the most frequent grade of the cartilage lesion (42%). The most common associated articular lesions were the medial meniscus tear (37%) and the injury of the anterior crucial ligament (36%). Articular cartilage lesions are a common pathology of the knee joint. The potential candidates for cartilage repair surgery, patients with one to three localized grade III and IV cartilage lesions, under the age of 40 were found in 7% and under the age of 50 years in 9% of all analysed patients. However, because these patients are a heterogeneous group and the natural history of cartilage lesions remains so far unknown, also the total number of patients in our study, who might benefit from cartilage repair, remains unknown precisely.

Articular Cartilage Repair in Soccer Players with Autologous Chondrocyte Transplantation

Background The ability of autologous chondrocyte transplantation to produce and maintain an effective articular cartilage repair under high mechanical demands has not been investigated. Hypothesis Autologous chondrocyte transplantation provides a reliable and durable repair of full-thickness knee articular cartilage lesions in high-demand athletes. Study Design Case series; Level of evidence, 4. Methods A total of 45 soccer players were evaluated 41 ± 4 months after autologous chondrocyte transplantation for their ability to return to soccer, the timing of their return, skill level, and functional outcome rating by the Tegner activity rating scale score and Brittberg score. The factors influencing the return to sport were analyzed. Results Of these players, 72% reported good to excellent results, with significant overall improvement of Tegner activity rating scale scores; 33% returned to soccer, including 83% of competitive-level players and 16% of recreational players. Of the returning players, 80% returned to the same skill level and 87% maintained their ability to play soccer at 52 ± 8 months postoperatively. Players who successfully returned to soccer were significantly younger and had a shorter preoperative duration of symptoms than did patients who did not return to the sport. Concomitant adjuvant procedures did not adversely affect the ability to return to soccer. Conclusion Repair of knee articular cartilage lesions by autologous chondrocyte transplantation in high-performance athletes is particularly successful in younger, competitive athletes with limited preoperative intervals.