New Procedure Bests Standard of Care for Fixing Damaged Cartilage

It is thought that fixing such lesions may ultimately help to prevent the onset of osteoarthritis, and get athletic individuals back to sporting activities reliably. The study by Hospital for Special Surgery (HSS) researchers was reported at the annual meeting of the American Academy of Orthopaedic Surgeons.

"Studies have shown that there is only about a 40 per cent return to sport after the microfracture procedure which is the standard of care treatment in the United States Over 90 per cent of patients return to sport with the OATS procedure, said Doctor Riley J. Williams, a sports medicine orthopaedic surgeon at HSS in New York City. "For those who have isolated cartilage lesions of the femur and are interested in a return to sport in a timely and predictable fashion, the OATS procedure, relative to microfracture, represents a better option."

For years, researchers have known that erosion of articular cartilage, the soft lining or cushion at the end of bones, can lead to symptomatic osteoarthritis. The cartilage can be damaged from normal wear and tear or from a traumatic injury. Once the cartilage is damaged, it continues to deteriorate. Athletes with progressive osteoarthritis are often forced to stop playing their sport of choice.

Over the years, researchers have developed a number of procedures for repairing cartilage in patients who range from roughly 16 to 50 years of age. The current standard of care is microfracture, an arthroscopic procedure that involves using a tiny pick to punch holes into the base of the damaged cartilage area.

This promotes bleeding and allows bone marrow cells to come to the surface of the damaged tissue. As a result, the cells then change into fibrocartilage cells and heal the defect. A study from the HSS Cartilage Registry showed that only about 40 per cent of athletes return to sport after this procedure. "40 per cent is such an abysmal rate of return to sport, which is why we keep looking for other repair methods to help our patients," said Williams.

The study found no difference in the knee outcome surveys or SF-36 form, but they did identify significant differences in the Marx Activity Level. Patients who underwent the OATS procedure had higher scores than patients who underwent microfracture at one year from baseline (score 5.21 versus 4.11), two years (7.29 versus 3.71), three years (7.75 versus 2.91) and five years (8.55 versus 2.89).

"The Marx activity rating scale correlates directly to the amount of physical activity that you can do at the time of the assessment," said Williams. "Patients who underwent the OATS were able to do more sports and more athletic activities compared to the microfracture group at the same time point. We now have another procedure which is likely to result in a return to sport more predictably."; Source: Hospital for Special Surgery