Scaffolds for Knee Chondral and Osteochondral Defects: Indications for Different Clinical Scenarios. A Consensus Statement
Year: 2020
Type: article
Abstract: OBJECTIVE: To develop patient-focused consensus guidelines on the indications for the use of scaffolds to address chondral and osteochondral femoral condyle lesions. DESIGN: The RAND/UCLA Appropriateness Method (RAM) was used to develop patient-specific recommendations by combining the best available scientific evidence with the collective judgement of a panel of experts guided by a core panel and multidisciplinary discussers. A list of specific clinical scenarios was produced regarding adult patients with symptomatic lesions without instability, malalignment, or meniscal deficiency. Each scenario underwent discussion and a 2-round vote on a 9-point Likert-type scale (range 1-3 "inappropriate," 4-6 "uncertain," 7-9 "appropriate"). Scores were pooled to generate expert recommendations. RESULTS: Scaffold (chondral vs. osteochondral), patient characteristics (age and sport activity level), and lesion characteristics (etiology, size, and the presence of osteoarthritis [OA]) were considered to define 144 scenarios. The use of scaffold-based procedures was considered appropriate in all cases of chondral or osteochondral lesions when joints are not affected by OA, while OA joints presented more controversial results. The analysis of the evaluated factors showed a different weight in influencing treatment appropriateness: the presence of OA influenced 58.3% of the indications, while etiology, size, and age were discriminating factors in 54.2%, 29.2%, and 16.7% of recommendations, respectively. CONCLUSIONS: The consensus identified indications still requiring investigation, but also the convergence of the experts in several scenarios defined appropriate or inappropriate, which could support decision making in the daily clinical practice, guiding the use of scaffold-based procedures for the treatment of chondral and osteochondral knee defects.
Source: Cartilage
Authors: Giuseppe Filardo, Luca Andriolo, Peter Angele, Massimo Berruto, Mats Brittberg, Vincenzo Condello, Susan Chubinskaya, Laura de Girolamo, Alessandro Di Martino, Berardo Di Matteo, Justus Gille, Alberto Gobbi, Christian Lattermann, Norimasa Nakamura, Stefan Nehrer, Giuseppe M. Peretti, Nogah Shabshin, Peter Verdonk, Kenneth Zaslav, Elizaveta Kon
Institutions: Istituto Ortopedico Rizzoli, University Hospital Regensburg, Istituto Ortopedico Gaetano Pini, Hallands sjukhus Kungsbacka, Region Halland, University of Gothenburg, Humanitas Castelli, Rush University Medical Center, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Humanitas University, IRCCS Humanitas Research Hospital, University Hospital Schleswig-Holstein, OASI Bioresearch Foundation, Brigham and Women's Hospital, Harvard University, Osaka Health Science University, Universität für Weiterbildung Krems, University of Milan, Emek Medical Center, University of Pennsylvania Health System, Clalit Health Services, Qatar Orthopaedic and Sports Medicine Hospital, Virginia Commonwealth University, Sechenov University
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2999607505