Abstract
Objectives:
Articular cartilage debridement (chondroplasty) is generally utilized to treat small chondral defects or unstable chondral flaps that have failed nonoperative management; however, its impact on clinical outcomes in patients with large chondral defects (≥2 cm²) in the setting of mild to moderate knee osteoarthritis (OA) has been less commonly reported. This study aims to evaluate patient-reported outcomes (PROs) following chondroplasty in patients with larger chondral defects.
Methods:
A retrospective review was performed using a prospectively maintained database of patients who underwent arthroscopic debridement for focal chondral defects. Areas of chondral defects were estimated with intraoperative arthroscopic measurements, and areas of all defects were summed for each patient. All patients had an ICD-10 diagnosis of knee osteoarthritis, Kellgren-Lawrence (KL) grades of 2 or 3 and had a minimum of 1-year postoperative follow-up. PROs assessed included the International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), and the Veterans Rand-12 Item (VR-12) (both physical and mental components). Statistical analysis was performed using paired t-tests to compare baseline and one-year follow-up data.
Results:
A total of 42 patients (16 males, 26 females) with a mean age of 49.38 ± 11.5 years and BMI of 30.56 ± 6.68 were included. The mean sum chondral defect area was 5.35 ± 2.79 cm² (range 2.25 – 11.50 cm²). The most common areas defects were noted were the MFC (17), Patella (16), and LFC (13). At one-year follow-up, significant improvements were noted in IKDC scores, with an average increase of 16.6 ± 18.02 points (p < 0.001), and KOOS JR, with an average increase of 11.08 ± 19.16 points (p = 0.0018). VR-12 physical scores also improved significantly, with a mean increase of 7.94 ± 9.9 points (p < 0.001). However, there was no statistically significant change in VR-12 mental scores (mean decrease of -5.18 ± 16.17; p = 0.059). No conversions to arthroplasty were noted at most recent follow-up.
Conclusions:
Articular cartilage debridement for large focal chondral defects in the setting of mild to moderate osteoarthritis results in significant improvements in physical function and knee-specific PROs at minimum one-year follow-up.