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Prognostic factors for the management of chondral defects of the knee and ankle joint: a systematic review.

  • Migliorini, Filippo1, 2
  • Maffulli, Nicola3, 4, 5
  • Eschweiler, Jörg6
  • Götze, Christian7
  • Hildebrand, Frank6
  • Betsch, Marcel8
  • 1 Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074, Aachen, Germany. [email protected]. , (Germany)
  • 2 Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany. [email protected]. , (Germany)
  • 3 Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy. , (Italy)
  • 4 School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Thornburrow Drive, Stoke on Trent, England.
  • 5 Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, London, E1 4DG, England.
  • 6 Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH University Hospital Aachen, 52074, Aachen, Germany. , (Germany)
  • 7 Department of Orthopaedics, Auguste-Viktoria-Klinik, 32545, Bad Oeynhausen, Germany. , (Germany)
  • 8 Department of Orthopaedics and Trauma Surgery, University Hospital Erlangen, 91054, Erlangen, Germany. , (Germany)
Published Article
European journal of trauma and emergency surgery : official publication of the European Trauma Society
Publication Date
Apr 01, 2023
DOI: 10.1007/s00068-022-02155-y
PMID: 36344653


Different surgical techniques to manage cartilage defects are available, including microfracture (MFx), autologous chondrocyte implantation (ACI), osteoarticular auto- or allograft transplantation (OAT), autologous matrix-induced chondrogenesis (AMIC). This study investigated the patient-related prognostic factors on the clinical outcomes of surgically treated knee and ankle cartilage defects. This study followed the PRISMA statement. In May 2022, the following databases were accessed: PubMed, Google Scholar, Embase, and Scopus. All the studies investigating the outcomes of surgical management for knee and/or talus chondral defects were accessed. Only studies performing mesenchymal stem cells transplantation, OAT, MFx, ACI, and AMIC were considered. A multiple linear model regression analysis through the Pearson Product-Moment Correlation Coefficient was used. Data from 184 articles (8905 procedures) were retrieved. Female sex showed a positive moderate association with visual analogue scale at last follow-up (P = 0.02). Patient age had a negative association with the American Orthopaedic Foot and Ankle Score (P = 0.04) and Lysholm Knee Scoring Scale (P = 0.03). BMI was strongly associated with graft hypertrophy (P = 0.01). Greater values of VAS at baseline negatively correlate with lower values of Tegner Activity Scale at last follow-up (P < 0.0001). The clinical outcomes were mostly related to the patients' performance status prior surgery. A greater BMI was associated with greater rate of hypertrophy. Female sex and older age evidenced fair influence, while symptom duration prior to the surgical intervention and cartilage defect size evidenced no association with the surgical outcome. Lesion size and symptom duration did not evidence any association with the surgical outcome. © 2022. The Author(s).

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