The management of cartilage defects of the knee and injection therapy - A collaborative and retrospective study

Knee cartilage defects are common and often encountered during arthroscopy, with an incidence of 60-66%. The aim of this study was to determine current strategies in the surgical and non-surgical management of symptomatic knee cartilage defects in the UK.

Adopting a collaborative study model, a survey was circulated to participating centres. This comprised of 21 questions, addressing the number and type of cartilage procedures performed within the past 5 years for isolated knee cartilage defects. Data was also collected on the type of injection therapy that was offered by each centre.

Data was analyzed from 19 centres across the UK. Over 5 years, 36,661 procedures were performed on patients with isolated cartilage defects. Chondroplasty and microfracture were performed most commonly, n = 6772 and n = 1579, respectively. AMIC, OATS and ACI were performed in fewer than 50 % of centres sampled, with actual procedure numbers 61, 29 and 176 respectively. Multiple centres combined cartilage procedures with ligament reconstruction (n = 2131, 10 centres), osteotomy (n = 1188, nine centres) and patellofemoral surgery (n = 1173, seven centres). Seventeen of 19 centres offered injections for knee pain. Corticosteroid therapies were most common (15/17); seven of 17 centres offered additional therapies (two of 17 PRP, three of 17 HA, two of 17 both PRP and HA).

This is the first nationwide study evaluating approaches to managing isolated cartilage defects and injection therapies. While chondroplasty and microfracture are most commonly used, there is significant variation in the use of AMIC, OATS, ACI, and injection treatments, suggesting inconsistent adherence to NICE guidelines in the management of chondral defects.