Outcomes of Revision Cartilage Restoration Surgery for Failed Primary Treatment of Chondral or Osteochondral Defects of the Knee: A Systematic Review

Abstract

Background: Failure of primary cartilage restoration procedures of the knee that proceed to necessitating revision cartilage procedures represent a challenging clinical scenario with variable outcomes reported in previous literature. Purpose: To perform a systematic review and meta-analysis of clinical outcomes and adverse events after revision cartilage restoration procedures of the knee for failed primary cartilage procedures. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: The PubMed, OVID/MEDLINE, and Cochrane databases were queried in August 2023 for trials reporting on the outcomes of revision cartilage restoration procedures of the knee. Information pertaining to rates of failure, reoperations, graft-related complications, and patient-reported outcome measures were extracted. A meta-analysis using inverse-variance proportion models using Freeman-Tukey double-arcsine transformations and DerSimonian-Laird random-effects estimators was constructed to quantitatively describe the cumulative incidence of adverse events. Results: Sixteen studies (1361 patients; mean age, 35.7 ± 9.3 years) were included. The most frequently performed revision cartilage procedure was autologous chondrocyte implantation (ACI; n = 755 [55.5%]). The overall rate of failure was 25.1% (95% CI, 14.4%-37.3%) at a mean 6.5 years (range, 2-26 years). The majority of studies (n = 9) reported a failure rate exceeding 20%. A significant reduction in failure was observed in favor of the revision osteochondral allograft cohort (19.0% [75/395] vs 35.7% [273/764]; relative risk, 0.63; P