Filardo, Giuseppe and Andriolo, Luca and Angele, Peter and Berruto, Massimo and Brittberg, Mats and Condello, Vincenzo and Chubinskaya, Susan and de Girolamo, Laura and Di Martino, Alessandro and Di Matteo, Berardo and Gille, Justus and Gobbi, Alberto and Lattermann, Christian and Nakamura, Norimasa and Nehrer, Stefan and Peretti, Giuseppe M. and Shabshin, Nogah and Verdonk, Peter and Zaslav, Kenneth and Kon, Elizaveta (2020) Scaffolds for Knee Chondral and Osteochondral Defects: Indications for Different Clinical Scenarios. A Consensus Statement. CARTILAGE: 1947603519. ISSN 1947-6035, 1947-6043
Full text not available from this repository. (Request a copy)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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | AUTOLOGOUS CHONDROCYTE TRANSPLANTATION; CARTILAGE REPAIR; LESIONS; IMPLANTATION; REGENERATION; STRATEGIES; GUIDELINE; OUTCOMES; SURGERY; scaffolds; cartilage; osteochondral; knee; osteoarthritis; guidelines |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Unfallchirurgie |
| Depositing User: | Petra Gürster |
| Date Deposited: | 24 Mar 2021 08:02 |
| Last Modified: | 24 Mar 2021 08:02 |
| URI: | https://pred.uni-regensburg.de/id/eprint/45344 |
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