Patient Profiling in Cartilage Regeneration.

Patient Profiling in Cartilage Regeneration. Prognostic Factors Determining Success of Treatment for Cartilage Defects.
Windt, T., Bekkers, J., Creemers, L., Dhert, W., Saris, D. American Journal of Sports Medicine; 2009, 37, 58 – 62.
www.ncbi.nlm.nih.gov/pubmed/19934438


Cartilage lesions are considered to be one of starting points for knee OA development. Cartilage injuries are usually treated with one of currently available surgical procedures. Treatment approach is usually dependent on patient’s history, patient’s expectation and preferences of the surgeon. The identification of patient characteristics that predict clinical outcome could be helpful in the development of patient-specific treatment strategies. Therefore, the aim of this study was to determine prognostic factors for knee articular cartilage lesion successful treatment.
Fifty-five patients were included in the final analysis. All patients had been treated for a focal articular cartilage lesion with  autologous chondrocyte implantation (ACI) using first-generation or second generation ACI or microfracturing. Patients received the KOOS questionnaire before and after (3 years) focal cartilage therapy.
Results showed that defect location and defect age proved to influence the KOOS improvement at 3 years after surgery. Medial defects were associated with a better KOOS improvement in all subdomains when compared with lateral defects. This finding seems to be confirmed by previous research where medial compartment repair had better improvement compared to lateral compartment which could be explained with less stress and pressure seen in medial knee part.
Patients without symptom-to-treatment delay would have 21.12 points more improvement in function in the sports and recreation subdomain when compared with patients with a significant treatment delay. A possible reason for the influence of defect age on clinical outcome is the better environment of fresh defects, with limited or localized cartilage matrix disturbance or degeneration in the surrounding tissue.
The single linear regression analysis of patient age showed that patients <30 years old had a significantly higher clinical improvement on the KOOS subdomains than did patients >30 years old.These findings could be related to the effects of aging on the senescence of cells and tissues and, thus, the extent of the regenerative response.
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