Elsevier

The Knee

Volume 14, Issue 3, June 2007, Pages 177-182
The Knee

Articular cartilage defects: Study of 25,124 knee arthroscopies

https://doi.org/10.1016/j.knee.2007.02.001Get rights and content

Abstract

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.

Introduction

The normal function of the knee joint depends on the presence of smooth surface with a low friction index. Such a surface is provided by articular cartilage. However, its vulnerability to various types of lesions may restrict the proper knee function and may lead to osteoarthritis [1].

Origins of articular cartilage surgery were derived from the ancient Greece where it was observed that cartilage once damaged should never heal. The introduction of arthroscopy to the knee surgery allowed for a detailed study of articular cartilage pathology and it initiated a rapid development of diagnostic and therapeutic methods. Although many new techniques have been introduced [2], [3], [4], [5], [6], [7], [8] the treatment of traumatic and non-traumatic cartilage lesions remains a controversial challenge. One of the most important problems is the need of a standardized international classification system which would allow for a reliable comparison and interpretation of results from different studies. Another serious problem is qualification for treatment. Which lesion needs treatment, which does not and then which method should be selected as the most appropriate [9], [10].

Numerous studies concerning the knee cartilage lesions have been performed [9], [11], [12], [13], [14], [15]. The purpose of this study is to provide data on the prevalence, epidemiology and etiology of the knee cartilage lesions. This is also an attempt to describe and estimate, on the ground of a large database, the number of patients suffering from chondropathy who might benefit from cartilage repair surgery.

Section snippets

Materials and methods

Two centres participated in the study. The retrospective analysis of 25,124 knee arthroscopies performed from 1989 to 2004 was conducted. The data for this study were retrieved from the Hospital Databases. The initial criteria for submission to arthroscopy were: diagnostics of acute knee injuries, diagnostics of unexplained knee pain and dysfunction, loose body, meniscal tears, osteoarthritis, cartilage repair, ACL reconstruction and others.

The detailed evaluation of the study group — patients

Results

Chondral lesions were found in 15,074 (60%) of 25,124 arthroscopies. In the years 1989–2004 the number of chondral lesions documented in arthroscopy ranged from 59% to 63%.

The study group, with diagnosed cartilage lesion, consisted of 66% male and 34% female patients. The average age of patients was 39 years and the largest group were patients aged 21–30 years (34%).

The analysis of the onset of symptoms revealed that in 58% it was a traumatic non-contact onset, usually connected with a day

Discussion

Articular cartilage lesions are a common pathology of the knee joint. Already since the times of Hippocrates it has been observed that cartilage once damaged should never heal. So far the natural history of cartilage lesions remains unpredictable and not well understood. At the same time new techniques have been introduced into the cartilage surgery, which has created a chance, as it has seemed, for solving the problem of choosing the best treatment method in different cartilage defects.

Conclusions

The indications for certain cartilage repair method, which are still very subjective, regarding the age, as well as the lesion depth and size vary and have changed for the last few years. Another problem is that patients suffering from chondropathy are a heterogeneous group and as Aroen et al. [9] indicated, the natural history of cartilage lesions remains so far unknown. That is why the total number of patients in our study, who might benefit from cartilage repair, also seems to be unknown

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