Concomitant Procedures Around Cartilage Restoration Surgery Is Associated With Improved Outcomes and Decreased Failure Rates: A Systematic Review.
Lucy E Meyer, Mikhail A Bethell, Eoghan T Hurley et al.
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In 30 seconds
This systematic review assessed whether concomitant osteotomy or meniscal allograft transplantation affects outcomes of cartilage restoration surgery. It included 40 studies comprising 1,783 knees; the underlying evidence consisted of Level II, III, and IV studies. Failure rates with concomitant osteotomy ranged from 0.0%-10.5%, compared with 0%-41.7% for cartilage restoration alone. Meniscal allograft transplantation was associated with improved Lysholm and International Knee Documentation Committee scores from preoperative ranges, while failure rates were comparable to cartilage restoration alone. Study heterogeneity varied widely.
Key findings
- With concomitant osteotomy, reported failure rates ranged from 0.0%-10.5%, versus 0%-41.7% with cartilage restoration alone.
- After cartilage restoration with meniscal allograft transplantation, Lysholm scores increased from 41.9-70.6 preoperatively to 63.6-88.0.
- International Knee Documentation Committee scores increased from 32.9-45.5 preoperatively to 55.3-76.0 after meniscal allograft transplantation.
- Failure rates with meniscal allograft transplantation were 14.0-15.2, comparable to 12.1-14.0 with cartilage restoration alone.
Why it matters
Cartilage restoration outcomes may depend on addressing associated mechanical problems, including malalignment and meniscal deficiency. This review suggests that adding osteotomy or meniscal allograft transplantation need not compromise overall outcomes, while highlighting that results vary across studies. The findings help frame concomitant procedures as relevant considerations when these mechanical factors are present.
What to keep in mind
The review included Level II, III, and IV studies, and heterogeneity ranged from 0% to 98%, limiting the consistency of comparisons.