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Scaffolds for Knee Chondral and Osteochondral Defects: Indications for Different Clinical Scenarios. A Consensus Statement


Cartilage. 2020 Jan 15;1947603519894729. doi: 10.1177/1947603519894729.Online ahead of print.

Giuseppe Filardo 1Luca Andriolo 2Peter Angele 3 4Massimo Berruto 5Mats Brittberg 6 7Vincenzo Condello 8Susan Chubinskaya 9Laura de Girolamo 10Alessandro Di Martino 2Berardo Di Matteo 11 12Justus Gille 13Alberto Gobbi 14Christian Lattermann 15Norimasa Nakamura 16Stefan Nehrer 17Giuseppe M Peretti 18 19Nogah Shabshin 20 21Peter Verdonk 22 23Kenneth Zaslav 24Elizaveta Kon 11 12 25

Author Information

1Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

2Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

3Clinic for Trauma and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Bayern, Germany.

4Sporthopaedicum Regensburg, Regensburg, Germany.

5UOS Knee SURGERY-1st University Clinic of Orthopaedics, ASST Pini-CTO, Milan, Italy.

6Cartilage Research Unit, University of Gothenburg, Gothenburg, Sweden.

7Region Halland Orthopaedics, Kungsbacka Hospital, Kungsbacka, Sweden.

8Joint Preservation and Reconstructive Surgery and Sports Medicine Unit, Humanitas Castelli Clinic, Bergamo, Lombardy, Italy.

9Department of Pediatrics, Orthopedic Surgery & Medicine (Section of Rheumatology), Rush University Medical Center, Chicago, IL, USA.

10Orthopaedic Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.

11Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.

12Humanitas Clinical and Research Center, Rozzano, Milan, Italy.

13Department of Trauma and Orthopaedic Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.

14Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, Milan, Italy.

15Department of Orthopaedic Surgery, Division of Sports Medicine, Center for Cartilage Repair, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

16Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan.

17Center for Regenerative Medicine, Danube University, Krems an der Donau, Austria.

18IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.

19Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.

20Department of Radiology, Emek Medical Center, Clalit Healthcare Services, Afula, Israel.

21Department of Radiology, PennMedicine, Philadelphia, PA, USA.

22ORTHOCA, AZ Monica Hospitals, Antwerp, Belgium.

23Aspetar Hospital, Doha, Qatar.

24Ortho Virginia, Virginia Commonwealth University, Richmond, VA, USA.

25Department of Traumatology, Orthopedics and Disaster Surgery, First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russian Federation.


Objective: To develop patient-focused consensus guidelines on the indications for the use of scaffolds to address chondral and osteochondral femoral condyle lesions.

Design: The RAND/UCLA Appropriateness Method (RAM) was used to develop patient-specific recommendations by combining the best available scientific evidence with the collective judgement of a panel of experts guided by a core panel and multidisciplinary discussers. A list of specific clinical scenarios was produced regarding adult patients with symptomatic lesions without instability, malalignment, or meniscal deficiency. Each scenario underwent discussion and a 2-round vote on a 9-point Likert-type scale (range 1-3 "inappropriate," 4-6 "uncertain," 7-9 "appropriate"). Scores were pooled to generate expert recommendations.

Results: Scaffold (chondral vs. osteochondral), patient characteristics (age and sport activity level), and lesion characteristics (etiology, size, and the presence of osteoarthritis [OA]) were considered to define 144 scenarios. The use of scaffold-based procedures was considered appropriate in all cases of chondral or osteochondral lesions when joints are not affected by OA, while OA joints presented more controversial results. The analysis of the evaluated factors showed a different weight in influencing treatment appropriateness: the presence of OA influenced 58.3% of the indications, while etiology, size, and age were discriminating factors in 54.2%, 29.2%, and 16.7% of recommendations, respectively.

Conclusions: The consensus identified indications still requiring investigation, but also the convergence of the experts in several scenarios defined appropriate or inappropriate, which could support decision making in the daily clinical practice, guiding the use of scaffold-based procedures for the treatment of chondral and osteochondral knee defects.