دورية أكاديمية
A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients.
العنوان: | A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients. |
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المؤلفون: | Jeuken RM; Maastricht University Medical Center, Maastricht, the Netherlands., van Hugten PPW; Maastricht University Medical Center, Maastricht, the Netherlands., Roth AK; Maastricht University Medical Center, Maastricht, the Netherlands., Timur UT; Maastricht University Medical Center, Maastricht, the Netherlands., Boymans TAEJ; Maastricht University Medical Center, Maastricht, the Netherlands., van Rhijn LW; Maastricht University Medical Center, Maastricht, the Netherlands., Bugbee WD; Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA., Emans PJ; Maastricht University Medical Center, Maastricht, the Netherlands. |
المصدر: | Orthopaedic journal of sports medicine [Orthop J Sports Med] 2021 Oct 15; Vol. 9 (10), pp. 23259671211031244. Date of Electronic Publication: 2021 Oct 15 (Print Publication: 2021). |
نوع المنشور: | Journal Article; Review |
اللغة: | English |
بيانات الدورية: | Publisher: Sage on behalf of: The American Orthopaedic Society for Sports Medicine Country of Publication: United States NLM ID: 101620522 Publication Model: eCollection Cited Medium: Print ISSN: 2325-9671 (Print) Linking ISSN: 23259671 NLM ISO Abbreviation: Orthop J Sports Med Subsets: PubMed not MEDLINE |
أسماء مطبوعة: | Original Publication: [Thousand Oaks, CA] : Sage on behalf of: The American Orthopaedic Society for Sports Medicine, [2013]- |
مستخلص: | Background: Focal cartilage defects are often debilitating, possess limited potential for regeneration, are associated with increased risk of osteoarthritis, and are predictive for total knee arthroplasty. Cartilage repair studies typically focus on the outcome in younger patients, but a high proportion of treated patients are 40 to 60 years of age (ie, middle-aged). The reality of current clinical practice is that the ideal patient for cartilage repair is not the typical patient. Specific attention to cartilage repair outcomes in middle-aged patients is warranted. Purpose: To systematically review available literature on knee cartilage repair in middle-aged patients and include studies comparing results across different age groups. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search was performed in EMBASE, MEDLINE, and the Cochrane Library database. Articles were screened for relevance and appraised for quality. Results: A total of 21 articles (mean Coleman Methodology Score, 64 points) were included. Two out of 3 bone marrow stimulation (BMS) studies, including 1 using the microfracture technique, revealed inferior clinical outcomes in middle-aged patients in comparison with younger patients. Nine cell-based studies were included showing inconsistent comparisons of results across age groups for autologous chondrocyte implantation (ACI). Bone marrow aspirate concentrate showed age-independent results at up to 8 years of follow-up. A negative effect of middle age was reported in 1 study for both ACI and BMS. Four out of 5 studies on bone-based resurfacing therapies (allografting and focal knee resurfacing implants [FKRIs]) showed age-independent results up to 5 years. One study in only middle-aged patients reported better clinical outcomes for FKRIs when compared with biological repairs. Conclusion: Included studies were heterogeneous and had low methodological quality. BMS in middle-aged patients seems to only result in short-term improvements. More research is warranted to elucidate the ameliorating effects of cell-based therapies on the aging joint homeostasis. Bone-based therapies seem to be relatively insensitive to aging and may potentially result in effective joint preservation. Age subanalyses in cohort studies, randomized clinical trials, and international registries should generate more evidence for the large but underrepresented (in terms of cartilage repair) middle-aged population in the literature. Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: W.D.B. has received consulting fees from JRF Ortho and Arthrex. P.J.E. has received consulting fees from Episurf and KioMed. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. (© The Author(s) 2021.) |
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فهرسة مساهمة: | Keywords: bone marrow stimulation; bone-based; cartilage; cell-based; middle-aged; repair |
تواريخ الأحداث: | Date Created: 20211022 Latest Revision: 20220427 |
رمز التحديث: | 20221213 |
مُعرف محوري في PubMed: | PMC8524698 |
DOI: | 10.1177/23259671211031244 |
PMID: | 34676269 |
قاعدة البيانات: | MEDLINE |
تدمد: | 2325-9671 |
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DOI: | 10.1177/23259671211031244 |