PMID- 31082325
OWN - NLM
STAT- MEDLINE
DCOM- 20200615
LR  - 20200615
IS  - 1552-3365 (Electronic)
IS  - 0363-5465 (Linking)
VI  - 47
IP  - 13
DP  - 2019 Nov
TI  - Comparative Effectiveness of Cartilage Repair With Respect to the Minimal 
      Clinically Important Difference.
PG  - 3284-3293
LID - 10.1177/0363546518824552 [doi]
AB  - BACKGROUND: Recent studies demonstrated a 5% increase in cartilage repair 
      procedures annually in the United States. There is currently no consensus 
      regarding a superior technique, nor has there been a comprehensive evaluation of 
      postoperative clinical outcomes with respect to a minimal clinically important 
      difference (MCID). PURPOSE: To determine the proportion of available cartilage 
      repair studies that meet or exceed MCID values for clinical outcomes improvement 
      over short-, mid-, and long-term follow-up. STUDY DESIGN: Systematic review and 
      meta-analysis. METHODS: A systematic review was performed via the Medline, 
      Scopus, and Cochrane Library databases. Available studies were included that 
      investigated clinical outcomes for microfracture (MFX), osteoarticular transfer 
      system (OATS), osteochondral allograft transplantation, and autologous 
      chondrocyte implantation/matrix-induced autologous chondrocyte implantation 
      (ACI/MACI) for the treatment of symptomatic knee chondral defects. Cohorts were 
      combined on the basis of surgical intervention by performing a meta-analysis that 
      utilized inverse-variance weighting in a DerSimonian-Laird random effects model. 
      Weighted mean improvements in International Knee Documentation Committee (IKDC), 
      Lysholm, and visual analog scale for pain (VAS pain) scores were calculated from 
      preoperative to short- (1-4 years), mid- (5-9 years), and long-term (>/=10 years) 
      postoperative follow-up. Mean values were compared with established MCID values 
      per 2-tailed 1-sample Student t tests. RESULTS: A total of 89 studies with 3894 
      unique patients were analyzed after full-text review. MFX met MCID values for all 
      outcome scores at short- and midterm follow-up with the exception of VAS pain in 
      the midterm. OATS met MCID values for all outcome scores at all available time 
      points; however, long-term data were not available for VAS pain. Osteochondral 
      allograft transplantation met MCID values for IKDC at short- and midterm 
      follow-up and for Lysholm at short-term follow-up, although data were not 
      available for other time points or for VAS pain. ACI/MACI met MCID values for all 
      outcome scores (IKDC, Lysholm, and VAS pain) at all time points. CONCLUSION: In 
      the age of informed consent, it is important to critically evaluate the clinical 
      outcomes and durability of cartilage surgery with respect to well-established 
      standards of clinical improvement. MFX failed to maintain VAS pain improvements 
      above MCID thresholds with follow-up from 5 to 9 years. All cartilage repair 
      procedures met MCID values at short- and midterm follow-up for IKDC and Lysholm 
      scores; ACI/MACI and OATS additionally met MCID values in the long term, 
      demonstrating extended maintenance of clinical benefits for patients undergoing 
      these surgical interventions as compared with MFX.
FAU - Jones, Kristofer J
AU  - Jones KJ
AD  - Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), 
      Los Angeles, California, USA.
FAU - Kelley, Benjamin V
AU  - Kelley BV
AD  - Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), 
      Los Angeles, California, USA.
FAU - Arshi, Armin
AU  - Arshi A
AD  - Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), 
      Los Angeles, California, USA.
FAU - McAllister, David R
AU  - McAllister DR
AD  - Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), 
      Los Angeles, California, USA.
FAU - Fabricant, Peter D
AU  - Fabricant PD
AD  - Hospital for Special Surgery, New York, New York, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20190513
PL  - United States
TA  - Am J Sports Med
JT  - The American journal of sports medicine
JID - 7609541
SB  - IM
MH  - Cartilage Diseases/*surgery
MH  - Cartilage, Articular/*surgery
MH  - Chondrocytes/transplantation
MH  - Fractures, Stress/surgery
MH  - Humans
MH  - Knee Injuries/surgery
MH  - Knee Joint/*surgery
MH  - Minimal Clinically Important Difference
MH  - Orthopedic Procedures/methods
MH  - Postoperative Period
MH  - Visual Analog Scale
OTO - NOTNLM
OT  - autologous chondrocyte implantation
OT  - microfracture
OT  - minimally important clinical difference
OT  - osteoarticular transfer system
OT  - osteochondral allograft transplantation
EDAT- 2019/05/15 06:00
MHDA- 2020/06/17 06:00
CRDT- 2019/05/15 06:00
PHST- 2019/05/15 06:00 [pubmed]
PHST- 2020/06/17 06:00 [medline]
PHST- 2019/05/15 06:00 [entrez]
AID - 10.1177/0363546518824552 [doi]
PST - ppublish
SO  - Am J Sports Med. 2019 Nov;47(13):3284-3293. doi: 10.1177/0363546518824552. Epub 
      2019 May 13.