A literature review published in the October issue of the American Journal of Bone and Joint Surgey concludes that clinical studies on cartilage repair are generally marked by a poor scientific method.
Researchers at Oslo Sport Trauma Research Center performed a literature search in well-known medical databases (Medline, Cochrane, EMBASE, and more) identifying 61 studies reporting results after surgical treatment of cartilage injuries with one of the following techniques: Periosteal transplantation, microfracture, mosaic plasty or autologous chondrocyte implantation.
The studies were scored using a modified version of the Coleman Methodology Score previously used in studies of Achilles and patellar tendinopathy. This score consists of 10 criteria based on the CONSORT-statement regarding randomised controlled trials. In this score the perfect clinical trial would recieve a score of 100.
The 61 studies included in the analysis reported on a total of 3987 surgical procedures. The average methodology score were 43.5. A number of criteria generally contributed to the low score among these type of study (retrospective, prospective or randomised controlled) and assessment of the postoperative result (the use of blinded, independent observer). It was also found that the reported postoperative result varied to a large extent within each treatment modality. Another finding was that 27 different clinical scoring systems were used to assess the postoperative result.
The review concludes that caution is required when interpreting results after surgical cartilage repair and that firm recommendations on which cartilage repair procedure to choose cannot be given at this time on the basis of these studies. Guidelines for future studies are also proposed.
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