Articular Cartilage Repair of the Pediatric and Adolescent Knee with Regard to Minimal Clinically Important Difference: A Systematic Review.
OBJECTIVE
To perform a systematic review of clinical outcomes following microfracture (MFX), autologous chondrocyte implantation (ACI), osteochondral allograft transplantation (OCA), and osteochondral autograft transplantation system (OATS) to treat articular cartilage lesions in pediatric and adolescent patients. We sought to compare postoperative improvements for each cartilage repair method to minimal clinically important difference (MCID) thresholds.


DESIGN
MEDLINE, Web of Science, Scopus, and Cochrane Library databases were searched for studies reporting MCID-validated outcome scores in a minimum of 5 patients ≤19 years treated for symptomatic knee chondral lesions with minimum 1-year follow-up. One-sample t tests were used to compare mean outcome score improvements to established MCID thresholds.


RESULTS
Twelve studies reporting clinical outcomes on a total of 330 patients following cartilage repair were identified. The mean age of patients ranged from 13.7 to 16.7 years and the mean follow-up was 2.2 to 9.6 years. Six studies reported on ACI, 4 studies reported on MFX, 2 studies reported on OATS, and 1 study reported on OCA. ACI (P < 0.001, P = 0.008) and OCA (P < 0.001) showed significant improvement for International Knee Documentation Committee (IKDC) scores with regard to MCID while MFX (P = 0.66) and OATS (P = 0.11) did not. ACI (P < 0.001) and OATS (P = 0.010) both showed significant improvement above MCID thresholds for Lysholm scores. MFX (P = 0.002) showed visual analog scale (VAS) pain score improvement above MCID threshold while ACI (P = 0.037, P = 0.070) was equivocal.


CONCLUSIONS
Outcomes data on cartilage repair in the pediatric and adolescent knee are limited. This review demonstrates that all available procedures provide postoperative improvement above published MCID thresholds for at least one reported clinical pain or functional outcome score.
['Valtanen|Rosa S|RS|', 'Arshi|Armin|A|0000-0002-3391-551X', 'Kelley|Benjamin V|BV|', 'Fabricant|Peter D|PD|', 'Jones|Kristofer J|KJ|']
D000293:Adolescent D054544:Arthroplasty, Subchondral D050376:Bone-Patellar Tendon-Bone Grafting D002357:Cartilage Diseases D002358:Cartilage, Articular D002648:Child D019902:Chondrocytes D005260:Female D015775:Fractures, Stress D006801:Humans D057072:Intra-Articular Fractures D007717:Knee D007718:Knee Injuries D008297:Male D000071081:Minimal Clinically Important Difference D010372:Pediatrics D014182:Transplantation, Autologous D014184:Transplantation, Homologous
autologous chondrocyte implantation osteochondral allograft cartilage injury pediatric knee