Summary

Fixation of pure chondral injuries in young patients may be an option, however better quality studies are required.

Abstract

Introduction

There is controversy whether pure cartilage lesions without osteochondral base can heal after fixation. In recent years, repair of pure injuries has been attempted. The objective of this review is to evaluate the outcomes of these interventions.

Methods

A systematic search over the last 20 years was carried out in PubMed, Medline, Cochrane and Epistemonikos, according to PRISMA guidelines. The search terms were: “Fixation”, “repair”, “Cartilage”, “Chondral”, “Fragment”, “Lesion”, “Pediatrics”, “Fracture” and “Knee”. Data was reviewed by 2 researchers. 2071 articles were found. Unrelated articles, cases of osteochondritis dissecans, osteochondral fragments, and reviews were excluded. 19 articles were reviewed in depth. Finally, 15 studies reporting fixation results in pure chondral lesions were included.

Results

1 retrospective study was included and the rest were case-series or case reports including a total of 89 patients. 74.4% were male and the average follow-up was 41.5 months (5 months - 9 years). The mean age was 16.9 years (10-36) and 16.2% were over 18 years old. The pooled success rate is 88% (81.2-94.7 95% CI). The fixation methods used include: bioabsorbable implants, transosseous sutures, osteochondral cylinders, among others. Complications are underreported, however implant removal was the most prevalent.

Conclusions

Fixation of pure chondral lesions shows variable results and heterogeneous fixation methods. The level of evidence in the literature is low and is mainly limited to case reports with significant bias. However, it appears that fixation of these lesions could have considerable success rates in the population studied. Nevertheless, to offer a recommendation, better quality studies are required.