Treatment selection in articular cartilage lesions of the knee: a systematic review.
BACKGROUND
Several treatment options are available to repair articular cartilage lesions of the knee; however, evidence-based parameters for treatment selection are lacking.


OBJECTIVE
To identify parameters for valid treatment selection in the repair of articular cartilage lesions of the knee.


METHODS
Systematic review.


METHODS
A systematic search was conducted in the databases EMBASE, MEDLINE, and the Cochrane collaboration. The retrieved articles were screened for relevance on title and abstract followed by a full-text study quality appraisal of the remaining articles. Eventually, a total of 4 randomized controlled trials were included.


RESULTS
Lesion size, activity level, and age were the influencing parameters for the outcome of articular cartilage repair surgery. Lesions greater than 2.5 cm(2) should be treated with sophisticated techniques, such as autologous chondrocyte implantation or osteochondral autologous transplantation, while microfracture is a good first-line treatment option for smaller (<2.5 cm(2)) lesions. Patients who are active show better results after autologous chondrocyte implantation or osteochondral autologous transplantation when compared with microfracture. Younger patients (<30 years) seem to benefit more from any form of cartilage repair surgery compared with those over 30 years of age.


CONCLUSIONS
Lesion size, activity level, and patient age are factors that should be considered in selecting treatment of articular cartilage lesions of the knee. In addition, these factors are a step toward evidence-based, instead of surgeon-preferred, treatment of articular cartilage lesions of the knee.
Bekkers
Joris E J
JE
Department of Orthopaedics, University Medical Centre, Utrecht, the Netherlands.
Inklaar
Melanie
M
Saris
Daniël B F
DB
D000328:Adult; D000368:Aged; D002358:Cartilage, Articular / Q000293:injuries* / Q000601:surgery*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010007:Osteochondritis; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult