Prognosis and treatement of focal cartilage lesions of the knee joint. Medium to long-term results
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AbstractThe articular cartilage of the knee joint is commonly injured, and the difficulty in treating these injuries has been recognized among orthopaedic surgeons for centuries. A focal cartilage lesion, isolated or concomitant to other intra-articular injuries, may cause pain and disturbed joint function in the often young and active individual. The present thesis is the result of the ambition to increase the knowledge on the medium-to long-term effects on prognosis of focal cartilage lesions of the knee joint, and the outcome following surgery. In paper I, we aimed to compare the long-term outcome following two commonly used surgical techniques for isolated cartilage lesions (Microfracture [MF] vs. Osteochondral Autologous Transplantation [OAT]). 25 patients were randomized to MF or OAT. At the 10-year follow-up, both treatment groups reported significant improvements in patient-reported outcome measures (PROMs) from baseline, but no between-group differences in PROMs, muscle strength deficits or radiographic osteoarthritis (OA) were detected. In papers II-IV, data from the Norwegian and Swedish national knee ligament registries were used to investigate if there were any differences in medium- to long-term PROMs in patients with and without concomitant cartilage lesions at the time of anterior cruciate ligament (ACL) reconstruction (paper II and III), and to investigate the effect of surgical treatment (debridement or MF versus no surgical treatment) of concomitant cartilage lesions (paper IV). We found that patients with concomitant cartilage lesions improved significantly less than patients without such lesions up to 5 years after ACL-reconstruction, and that the surgical treatment strategy of debridement or MF of concomitant full-thickness cartilage lesions in the setting of ACL-reconstruction conferred no benefit over nonoperative treatment.
List of papers
|Paper I: Ulstein S, Årøen A, Røtterud JH, Løken S, Engebretsen L, Heir S. Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee: a prospective randomized trial with long-term follow-up. Knee Surg Sports Traumatol Arthrosc. 2014;22(6):1207-1215. The article is included in the thesis. The published version is available at: https://doi.org/10.1007/s00167-014-2843-6|
|Paper II: Ulstein S, Bredland K, Årøen A, Engebretsen L, Røtterud JH. No negative effect on patientreported outcome of concomitant cartilage lesions 5-9 years after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2016;25(5):1482-1488. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1007/s00167-016-4163-5|
|Paper III: Ulstein S, Årøen A, Engebretsen L, Forssblad M, Lygre SHL, Røtterud JH. Effect of Concomitant Cartilage Lesions on Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: A Nationwide Cohort Study From Norway and Sweden of 8470 Patients With 5-Year Follow-up. Orthop J Sports Med. 2018;6(7):2325967118786219. The article is included in the thesis. The published version is available at: https://doi.org/10.1177/2325967118786219|
|Paper IV: Ulstein S, Årøen A, Engebretsen L, Forssblad M, Lygre SHL, Røtterud JH. A Controlled Comparison of Microfracture, Debridement, and No Treatment of Concomitant Full- Thickness Cartilage Lesions in Anterior Cruciate Ligament-Reconstructed Knees: A Nationwide Prospective Cohort Study From Norway and Sweden of 368 Patients With 5-Year Follow-up. Orthop J Sports Med. 2018;6(8):2325967118787767. The article is included in the thesis. The published version is available at: https://doi.org/10.1177/2325967118787767|