Treatment of chondral defects in the athlete's knee.
OBJECTIVE
To determine which surgical technique(s) has improved outcomes and enables athletes to return to their preinjury level of sports and which patient and defect factors significantly affect outcomes after cartilage repair or restoration.


METHODS
We conducted a search of multiple medical databases, evaluating studies of articular cartilage repair in athletes.


RESULTS
We identified 11 studies for inclusion (658 subjects). Only 1 randomized clinical trial was identified. All other studies were prospective cohorts, case-control studies, or case series reporting results after either microfracture or autologous chondrocyte implantation (ACI) or osteoarticular transplantation (OATS). Eight different clinical outcomes measures were used. Better clinical outcomes were observed after ACI and OATS versus microfracture. Results after microfracture tended to deteriorate with time. The overall rate of return to preinjury level of sports was 66%. The timing of return to the preinjury level of sports was fastest after OATS and slowest after ACI. Defect size of less than 2 cm(2), preoperative duration of symptoms of less than 18 months, no prior surgical treatment, younger patient age, and higher preinjury and postsurgical level of sports all correlated with improved outcomes after cartilage repair, especially ACI. Results after microfracture were worse with larger defects. The rate of return to sports was generally lower after microfracture versus ACI or OATS, and if a patient was able to return to sports, performance was diminished as well.


CONCLUSIONS
Management of chondral defects in the athlete is complex and multifactorial. There is little high-level evidence to support one procedure over another, although good short-term and midterm outcomes with a fair rate of return to preinjury level of sports can be achieved with cartilage repair and restoration in the athlete.


METHODS
Level IV, systematic review.
Department of Orthopaedics, Division of Sports Medicine Cartilage Repair Center, The Ohio State University Medical Center, 2050 Kenny Road, Columbus, OH 43221, USA.
Joshua D
JD
Harris
Robert H
RH
Brophy
Robert A
RA
Siston
David C
DC
Flanigan
D000367:Age Factors; D054544:Arthroplasty, Subchondral; D001265:Athletic Injuries / Q000601:surgery*; D016025:Bone Transplantation; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery*; D016022:Case-Control Studies; D019902:Chondrocytes / Q000637:transplantation; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008592:Menisci, Tibial / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000070600:Tibial Meniscus Injuries; D014182:Transplantation, Autologous; D016896:Treatment Outcome