Concomitant Procedures Around Cartilage Restoration Surgery Is Associated With Improved Outcomes and Decreased Failure Rates: A Systematic Review

To evaluate the current literature to determine the impact of concomitant alignment or meniscal surgery on outcomes in patients undergoing cartilage restoration surgery. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines utilizing a comprehensive search of MEDLINE, EMBASE, and The Cochrane Library databases. Studies were included if they reported clinical outcomes of cartilage restoration with concomitant osteotomy or meniscal allograft transplantation performed. Data extraction included functional outcomes, failure rates, and International Cartilage Repair Society/Magnetic Resonance Observation of Cartilage Repair Tissue scores. A total of 40 studies, comprising 1783 knees, were included. Patients undergoing cartilage restoration with concomitant osteotomy had a lower range of failure rates (0.0%-10.5%) compared with cartilage restoration alone (0%-41.7%). Similarly, cartilage repair with meniscal allograft transplantation had increased Lysholm and International Knee Documentation Committee scores from preoperative ranges of 41.9-70.6 and 32.9-45.5 to 63.6-88.0 and 55.3-76.0, respectively. The failure rates for cartilage restoration with concomitant meniscal allograft transplantation (range: 14.0-15.2) were comparable to cartilage restoration alone (range: 12.1-14.0). Additionally, the mean heterogeneity within the included studies ranged from 0% to 98%. Available evidence suggests that osteotomy and meniscal allograft transplantation can be performed concomitantly with cartilage restoration without adversely affecting overall outcomes. These procedures may be particularly relevant for patients with malalignment or meniscal deficiency, where mechanical factors contribute to disease progression. Level IV, systematic review of Level II, III, and IV studies.