Knee cartilage surgery: epidemiology, research methods and a proposal for improved surveillance

Abstract

Focal articular cartilage defects (FCDs) of the knee are identified in 20% of knee arthroscopies and are affecting a large and severly troubled group of young, adult patiens. FCDs may subsequently lead to knee osteoarthritis (OA). An obvious treatment goal is repair of the cartilage defect allowing patients to live their usual life and delay, or better still in the long run, avoid, joint replacement surgery, Existing treatments involve physical trainingm palliating surgical procedures, bone marrow-stimulating techniques and more advanced cartilage surgery. The results from clinical cohort studies and randomized controlled trials (RCTs) are conflicting, and no current gold-standard treatment exists. RCTs assess efficacy of interventions, but the effectiveness of cartilage surgery is unknown. Furthermore, cartilage surgery has not been compared to non-operative treatment under randomized and controlled conditions. In addition, the methodological quality of the majority of published studies is low. It is time for a comprehensive and standardized long-time follow-up of these patients, preferably through a register. However, there are some limitations and challenges that must be cleared out in advance.

Paper I: Engen, C. N., Årøen, A., Engebretsen, L. (2015). Incidence of knee cartilage surgery in Norway, 2008-2011. BMJ Open, 5. doi: 10.1136/bmjopen-2015-008423

Paper II: Engen, C. N., Engebretsen, L., Årøen, A. (2010). Knee Cartilage Defect Patients Enrolled in Randomized Controlled Trials Are Not Representative of Patients in Orthopedic Practice. Cartilage, 1, 312-319.

Paper III: Engen, C. N., Løken, S., Årøen, A., Ho C., Engebretsen L. (2016). No degeneration found in focal cartilage defects evaluated with dGEMRIC at 12-year follow-up. Acta Orthopaedica, 88, 82-89.

Paper IV: Engen, C. N., Årøen, A., Engebretsen L. (2016). Development of a pilot cartilage surgery register. Manuscript, submitted to BMC musculoskeletal disorders.