Abstract
Management of cartilage lesions of the knee can be complex, time consuming, and controversial,
especially without a widely agreed upon “gold-standard” management. The PearlDiver
database (www.pearldiverinc.com, Fort Wayne, IN) was queried for surgical management of cartilage lesions specified
by Current Procedure Terminology (CPT) codes: 29877, chondroplasty; 29879, microfracture/drilling;
29866, arthroscopic osteochondral autograft; 29867, arthroscopic osteochondral allograft;
27412, autologous chondrocyte implantation (ACI); 27415, open osteochondral allograft;
or 27416, open osteochondral autograft. Procedures were categorized as palliative
(chondroplasty), microfracture/drilling, or restorative (arthroscopic osteochondral autograft; arthroscopic osteochondral
allograft; ACI; open osteochondral allograft; or open osteochondral autograft). Linear
regression was performed to determine the significance of yearly trend across each
procedure.
From 2007 to 2016, a total of 35,506 surgical procedures were performed. The average
yearly incidence was 7.8 per 10,000 patients. Overall, palliative techniques (chondroplasty)
were more common (1.8:1 ratio for chondroplasty to microfracture and 34:1 ratio chondroplasty to restoration procedure). There was a trend of decreasing
incidence of palliative procedures seen by a significant decrease in the ratio of
palliative to microfracture/restorative procedures of 0.2512 each year from 2007 to 2016 (p < 0.001). This decrease followed a linear trend (R
2 = 0.9123). In 2013, the number and incidence of the palliative procedures declined below that of microfracture procedures, with microfracture being most common from 2013 to 2016. Palliative chondroplasty was no longer the most
commonly performed procedure for cartilage lesions in the United States from 2007
to 2016, as more surgeons opted for microfracture procedures instead. Restorative
procedures (ACI, osteochondral autograft transfer system) remained unchanged over
the study period, in accordance with the sports medicine literature; however, early
functional outcomes studies do show the equivalency and in some cases superiority
compared with microfracture. This is Level III study.
Keywords
cartilage - chondroplasty - microfracture - ACI - OATS
