Single-stage autologous cartilage repair results in positive patient-reported outcomes for chondral lesions of the knee: a systematic review

Abstract

Aim: This article aims to perform a systematic review of the clinical literature regarding the efficacy of single-stage autologous cartilage repair.

Methods: A systematic review of the literature was performed using PubMed, Scopus, Web of Science, and the Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.

Results: Twelve studies were identified; however, due to overlapping patient cohorts, nine studies were included for data extraction and analysis. Six studies applied minced cartilage, while three studies utilized enzymatically processed cartilage. Two authorship groups described single-stage techniques that exclusively utilized cartilage from the debrided lesion rim, while the remaining groups either utilized healthy cartilage or combined healthy cartilage with cartilage debrided from lesion rim. Among the included techniques, scaffold augments were used in four studies, and three studies implemented bone autograft augmentation. When summarizing patient reported outcome measures for the included studies, single-stage autologous cartilage repair demonstrated an average improvement ranging from 18.7 ​± ​5.3 to 30.0 ​± ​8.0 amongst the Knee Injury and Osteoarthritis Outcome Scores subsections, 24.3 ​± ​10.5 for the International Knee Documentation Committee subjective score, and 41.0 ​± ​10.0 for Visual Analogue Scale-Pain.

Conclusion: Single-stage autologous cartilage repair is a promising technique with positive clinical data to date. The current study highlights the overall improvement in patient reported outcomes after repair for chondral defects to the knee with average follow-up ranging from 12 to 201 months and also the heterogeneity and variability of the single-stage surgical technique. Further discussion on the standardization of practices for a cost-effective single-stage augmented autologous cartilage technique is needed. In the future, a well-designed randomized controlled trial is needed to explore the efficacy of this therapeutic modality relative to established intervention.

Level of evidence: Systematic review; Level IV.

Keywords: Chondral lesions; Knee; Minced cartilage; Single-stage autologous cartilage repair.