The Journal of Bone and Joint Surgery (American). 2005;87:2232-2239.
doi:10.2106/JBJS.D.02904
© 2005 The Journal of Bone and Joint Surgery, Inc.
An Analysis of the Quality of Cartilage Repair Studies
Rune B. Jakobsen1,
Lars Engebretsen, MD, PhD2 and
James R. Slauterbeck, MD, PhD3
1 Oslo Sports Trauma Research Center, Norwegian University of Sport and Physical
Education, PB 4014 Ullevaal Stadion, N-0806 Oslo, Norway. E-mail address:
r.b.jakobsen{at}medisin.uio.no
2 Orthopaedic Center, Ullevaal University Hospital, 0407 Oslo, Norway
3 McClure Musculoskeletal Research Center, Department of Orthopaedics and
Rehabilitation, University of Vermont, Burlington, VT 05405-0084
Investigation performed at the Oslo Sports Trauma Research Center and
the Orthopaedic Center, Ullevaal University Hospital, Oslo, Norway
In support of their research or preparation of this manuscript, one or more
of the authors received grants or outside funding from the Orthopaedic
Research and Education Foundation Clinician Scientist Award. None of the
authors received payments or other benefits or a commitment or agreement to
provide such benefits from a commercial entity. No commercial entity paid or
directed, or agreed to pay or direct, any benefits to any research fund,
foundation, educational institution, or other charitable or nonprofit
organization with which the authors are affiliated or associated.
Background: Most lesions of articular cartilage do not heal
spontaneously and may lead to secondary osteoarthritis. It is not known
whether the optimistic reports on the short and long-term results of several
different cartilage repair techniques are based on sound methodological
quality.
Methods: We performed a literature search in MEDLINE, CINAHL, the
Cochrane Central Register, and EMBASE and included studies in which the
primary aim of the investigation was to report the outcome after cartilage
repair in the knee with use of microfracture, autologous osteochondral
transplantation, autologous periosteal transplantation, or autologous
chondrocyte implantation. We scored the quality of the studies using a
modified Coleman Methodology Score with ten criteria, which results in a final
score between 0 and 100. Studies were also assessed with use of the
level-of-evidence rating used in the American Volume of The Journal of
Bone and Joint Surgery. We collected data on the year of publication, the
reported postoperative results, and the outcome measures used to assess the
results.
Results: Sixty-one studies involving a total of 3987 surgical
procedures were included. The average methodology score was 43.5 of 100.
Methodological deficiencies were found with respect to five criteria: the type
of study, description of the rehabilitation protocol, outcome criteria,
outcome assessment, and subject selection process. Large variations in the
reported outcome were seen within each treatment modality, and no significant
differences were found between each kind of therapy (p = 0.11). The
methodology score correlated positively with the level-of-evidence rating (r =
0.668, p < 0.0001), but there were large variations in the methodology
score within each level. The linear regression analysis weighted by the number
of patients demonstrated a negative yet not significant correlation between
the methodology score and the results reported in nineteen studies with use of
the Lysholm Scale (r = -0.29, p = 0.19). A total of twenty-seven different
clinical outcome measurement scales were used to assess outcome.
Conclusions: The generally low methodological quality found in the
studies included in this analysis indicates that caution is required when
interpreting results after surgical cartilage repair. Firm recommendations on
which procedure to choose cannot be given at this time on the basis of these
studies. More attention should be paid to methodological quality when
designing, performing, and reporting clinical studies.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.
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