A retrospective analysis of two independent prospective cartilage repair studies: autogenous perichondrial grafting versus subchondral drilling 10 years post-surgery.
BACKGROUND
Experimental data indicate that perichondrial grafting to restore articular cartilage defects will result in repair with hyaline-like cartilage. In contrast. debridement and drilling results in repair with fibro-cartilage. In this retrospective study the long-term clinical results of both procedures were compared to evaluate the theoretical benefit of repair with hyaline-like tissue.


METHODS
From two independent studies patients were selected with a cartilage defect in their knee. The selection was performed using strict inclusion criteria published elsewhere [Bouwmeester et al. Int. Orthop. 21 (1997) 313]. The patients were treated with either a perichondrium transplantation (PT group, n = 14) or with an 'open' debridement and drilling procedure (DD group, n = 11). The results of both procedures after 10-11 years were evaluated using the Hospital for Special Surgery Knee Score (HSSS), X-ray examination, clinical examination and visual analogue scales (VAS) for pain during walking and at rest.


RESULTS
Both procedures resulted in a general improvement compared to the situation before the operation. After an average of 10 years in the PT group there were three failures, in the DD group none, success rates were 78% and 100%, respectively. When comparing the successful PT patients with the DD patients, there were no differences in HSSS and VAS data. Both groups showed an equal number of irregular operation surface sites on X-ray (PT 9/11 versus DD 8/10).


CONCLUSIONS
This study shows that clinically at 10 years follow-up no difference was observed between debridement and drilling and perichondrium transplantation for treatment of an isolated cartilage defect. This raises questions about ongoing research to develop methods in order to improve the results of debridement and drilling as therapy for an isolated cartilage defect in a young patient (< or = 40 years).
Bouwmeester
Phianne S J M
PS
Kliniek Klein Rosendael, Velp, The Netherlands.
Kuijer
Roel
R
Homminga
George N
GN
Bulstra
Sjoerd K
SK
Geesink
Rudolph G T
RG
D000293:Adolescent; D000328:Adult; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003238:Connective Tissue / Q000637:transplantation*; D003646:Debridement; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D011446:Prospective Studies; D011859:Radiography; D014184:Transplantation, Homologous; D016896:Treatment Outcome