Although chondral defects in the knee are a common source of pain in athletes, the accuracy of diagnosing and staging these injuries with magnetic resonance imaging (MRI) is questionable: MRI has a specificity as low as 73% and a sensitivity of only 42%.
A study from researchers at The Rothman Institute has now provided empirical evidence that staging arthroscopy is more accurate than MRI in determining the appropriate treatment for patients with lesions in the chondral area of the knee. These findings were presented at the 2019 Annual Meeting of the American Orthopedic Society of Sports Medicine.
Between January 2005 and May 2015, 98 patients of The Rothman Institute were scheduled for autologous chondrocyte implantation (ACI), osteochondral allograft transplantation (OCA), or meniscus allograft transplantation (MAT) for treatment of chondral defects of the knee. Initially, the diagnosis and treatment plan was developed based on patient symptoms, MRI results, and any previous operative records. Patients then underwent staging arthroscopy.
The researchers wanted to know if staging arthroscopy changed the proposed treatment plan for these patients. In nearly half of cases, the answer was yes.
“Based on our review, a change in treatment plan was made in 47% percent of cases in which staging arthroscopy was used to evaluate articular cartilage surfaces,” said lead author Hytham S. Salem, MD.
The surgeons had initially diagnosed 86 patients with articular cartilage pathology and 12 with meniscal deficiency. After staging arthroscopy, the surgeons determined that 14 patients had additional defects and needed cartilage restoration surgery and 13 patients did not actually need cartilage restoration surgery and could be treated with debridement chondroplasty.
The surgeons also changed the treatment plan from ACI to OCA in 4 patients and from OCA to ACI in 1 patient. A patient who was schedule for MAT did not need the procedure, but a patient who was not scheduled for MAT did. Staging arthroscopy also helped surgeons choose between OCA and ACI in 19 cases: 8 underwent OCA, 8 underwent ACI, and 3 were determined to need different treatments (1 minced juvenile cartilage allograft transplant and 2 debridement chondroplasty only).
“The results of our study indicate that staging arthroscopy is an important step in determining the most appropriate treatment plan for chondral defects prior to OCA, ACI and MAT,” Dr. Salem said. “Addressing all [of a] knee’s pathology can be important for the success of cartilage restoration surgery, and treatment plans may change based on the extent and location of cartilage damage.”
Salem HS, Chaudhry Z, Lucenti, L, Tucker BS, Freedman KB. The Importance of Staging Arthroscopy for Chondral Defects of the Knee (Paper 15). Presented at the 2019 Annual Meeting of the American Orthopedic Society of Sports Medicine, July 11-14, 2019, Boston, Massachusetts.