Cartilage Conundrum: Investigating Outcomes in Knee Cartilage Restoration Techniques.

Background: Management of chondral injury can be difficult due to the avascularity of articular cartilage and the limited ability to proliferate and promote repair. Untreated lesions can lead to early development of arthritis and the need for joint replacement. For intermediate-sized lesions, osteochondral autograft transfer and autologous cell-based cartilage treatment have been accepted as the most effective treatment options. Purpose: To investigate the rates of complications within 2 years of initial surgery in patients who undergo primary autologous cell-based cartilage treatment and osteochondral autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was performed on July 17, 2024, using a commercially available insurance claims database to investigate 2-year orthopaedic complication rates in 1298 patients after primary osteochondral autograft and autologous cell-based cartilage treatment for chondral injuries of the knee. Patient cohorts were propensity score matched with a caliper set to 0.2 at a ratio of 1 to 1 on the following variables: age, sex, diabetes, and tobacco use. Rates of surgical complications were compared using multivariable logistic regression, adjusted for age, sex, diabetes, obesity, and tobacco use. Odds ratios (ORs) with corresponding 95% CIs were calculated for each comparison. Results: A total of 1298 patients were included in this retrospective analysis. Patients who underwent autologous cell-based cartilage treatment were significantly more likely to need revision cartilage restoration surgery compared with those who underwent osteochondral autograft treatment (11.1% vs 7.4%; OR, 1.58 [95% CI, 1.08-2.34]). There was no significant difference in the rate of progression to osteoarthritis (11.4% vs 10.6%; OR, 1.15; [95% CI, 0.80-1.65]) or subsequent knee arthroplasty (0.5% vs 1.1%; OR, 0.54 [95% CI, 0.11-2.06]) within 2 years of initial procedure between the treatment cohorts. Conclusion: This study highlights the increased risk of revision for patients who underwent autologous cell-based cartilage treatment compared with those who underwent osteochondral autograft treatment. However, no significant difference was identified in progression to osteoarthritis or subsequent knee arthroplasty within 2 years after the initial procedure. Further studies that evaluate long-term outcomes and the progression of symptoms are needed.