Abstract
This study aims to evaluate the trends in treatment of knee articular cartilage lesions
over the past decade using data obtained from the American Board of Orthopaedic Surgery
(ABOS) Part II database. The ABOS Part II database was queried from 2004 to 2013 for
chondroplasty, microfracture, and osteochondral grafting procedures. All cases were
analyzed for patient age and operating surgeon's fellowship training status. Univariate
analysis including chi-square test for categorical variables and Student's t-test for continuous variables was performed to determine if any significant changes
in practice patterns were present. Linear regression analyses were utilized to examine
temporal trends in procedures performed and fellowship training status. From 2004
to 2013, 25,938 procedures addressing articular cartilage lesions from 3,586 surgeons
were identified in the ABOS database. 46.8% of these orthopaedic surgeons had completed
a 1-year sports medicine fellowship. Sixty-six percent of cartilage surgeries were
performed by sports medicine-trained surgeons. The articular cartilage surgical volume
decreased from 3,126 cases in 2004 to 1,690 cases in 2013. The most common procedure
coded overall was chondroplasty (80.23%) followed by microfracture (21.37%) and osteochondral
grafting (2.1%). The mean age of patients undergoing chondroplasty was 46.9 years;
this was significantly higher than microfracture (mean age 40.5 years) or osteochondral
grafting procedures (mean age 31.6 years), p < 0.0005. The age of all patients undergoing cartilage surgery significantly decreased
between 2004 and 2013, p < 0.001. A dramatic decrease in reported chondroplasty volume was observed between
2011 and 2012. Concurrent osteotomies were used in <1% of procedures addressing cartilage
injuries, while 65% of patients underwent concurrent meniscectomy. These described
trends are most pronounced in surgeons with sports medicine fellowship training. In
conclusion, knee articular cartilage surgical volume and patient age have both sharply
declined since 2011, a trend driven by sports medicine-trained Part II examinees.
This trend correlates with changes in billing and coding practices, as well as improved
education from high-level studies.
Keywords
cartilage surgery - microfracture - chondroplasty - osteochondral grafting - OATS
