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Orthop J Sports Med. 2018 Oct 18;6(10):2325967118801931. doi: 10.1177/2325967118801931. eCollection 2018 Oct.

Do Focal Chondral Defects of the Knee Increase the Risk for Progression to Osteoarthritis? A Review of the Literature.

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1
Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA.
2
Department of Orthopaedic Surgery, St Joseph's Regional Medical Center, Paterson, New Jersey, USA.

Abstract

Background:

Focal chondral defects (FCDs) of the knee are believed to contribute to the development of osteoarthritis (OA), resulting in pain and dysfunction.

Purpose:

To investigate whether untreated FCDs of the knee progress to radiographically evident OA over time.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

A literature review was performed by searching the PubMed, Embase, and Cochrane Library databases to locate studies evaluating clinical and/or radiological outcomes of patients with FCDs that were diagnosed by arthroscopic surgery or magnetic resonance imaging (MRI) and were left untreated with a minimum 2-year follow-up. Additionally, studies were included if there was a radiographic assessment of OA. Search terms used were "knee," "focal," "isolated," "chondral," "cartilage," and "osteoarthritis." Studies were evaluated based on clinical/radiological outcomes and OA risk factors. The study methodology was assessed using the modified Coleman Methodology Score.

Results:

Eight studies comprising 1425 knees met the inclusion criteria. All studies were of level 3 evidence. The risk of incident cartilage damage (enlargement of original FCDs or incidence of additional FCDs) at latest follow-up was assessed in 3 studies, while 1 study only reported the incidence of cartilage damage at follow-up. All 4 studies noted an increased progression of cartilage damage at follow-up. The progression of cartilage damage was most commonly seen in the patellofemoral joint and medial femoral condyle but was not associated with the development of knee OA based on the Kellgren-Lawrence grade. MRI of the FCDs revealed increased water content, cartilage deterioration, and proteoglycan loss within the medial and lateral compartments.

Conclusion:

Patients with untreated FCDs of the knee joint are more likely to experience a progression of cartilage damage, although the studies included in this review did not demonstrate the development of radiographically evident OA within 2 years of follow-up.

KEYWORDS:

cartilage; focal chondral defect; knee; osteoarthritis

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: R.M.F. has received educational funding from Smith & Nephew and Arthrex. E.C.M. receives royalties from Biomet and Elsevier; is a consultant for Biomet and DePuy; and receives research support from Biomet, Mitek, Smith & Nephew, and Stryker. J.T.B. is a consultant for DJ Orthopaedics, Shukla Medical, Encore Medical, and Smith & Nephew; receives royalties from Shukla Medical; receives research support from Stryker; has received hospitality payments from Encore Medical and Smith & Nephew; and has received fellowship funding from Smith & Nephew, Mitek, and Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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