{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:19:38Z","timestamp":1793830778204,"version":"4.6.1"},"reference-count":40,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Failure of primary cartilage restoration procedures of the knee that proceed to necessitating revision cartilage procedures represent a challenging clinical scenario with variable outcomes reported in previous literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To perform a systematic review and meta-analysis of clinical outcomes and adverse events after revision cartilage restoration procedures of the knee for failed primary cartilage procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis; Level of evidence, 4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The PubMed, OVID\/MEDLINE, and Cochrane databases were queried in August 2023 for trials reporting on the outcomes of revision cartilage restoration procedures of the knee. Information pertaining to rates of failure, reoperations, graft-related complications, and patient-reported outcome measures were extracted. A meta-analysis using inverse-variance proportion models using Freeman-Tukey double-arcsine transformations and DerSimonian-Laird random-effects estimators was constructed to quantitatively describe the cumulative incidence of adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Sixteen studies (1361 patients; mean age, 35.7 \u00b1 9.3 years) were included. The most frequently performed revision cartilage procedure was autologous chondrocyte implantation (ACI; n = 755 [55.5%]). The overall rate of failure was 25.1% (95% CI, 14.4%-37.3%) at a mean 6.5 years (range, 2-26 years). The majority of studies (n = 9) reported a failure rate exceeding 20%. A significant reduction in failure was observed in favor of the revision osteochondral allograft cohort (19.0% [75\/395] vs 35.7% [273\/764]; relative risk, 0.63;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .0001) compared with the revision ACI cohort. The pooled all-cause reoperation event rate was 40.8%, which ranged between 18.2% and 71.4% (13 studies). Of these studies, 12 reported reoperation rates exceeding 20%, and 7 reported rates exceeding 40%. The pooled graft-related complication event rate was 27.2%, which ranged between 5.4% and 56.6% (11 studies). Notably, all analyses demonstrated considerable or moderate heterogeneity, potentially influencing the observed variability in pooled effect estimates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>One of every 4 patients may experience a secondary failure after undergoing a revision cartilage procedure. Revision using an osteochondral allograft may confer a meaningful reduction in the risk of failure relative to revision using ACI. High rates of graft-related complications and reoperations are also frequently observed in this population, highlighting the challenge of treating patients with failed primary treatment of chondral or osteochondral defects of the knee.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465241260271","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T04:02:20Z","timestamp":1736136140000},"page":"1515-1523","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Outcomes of Revision Cartilage Restoration Surgery for Failed Primary Treatment of Chondral or Osteochondral Defects of the Knee: A Systematic Review"],"prefix":"10.1177","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0363-3482","authenticated-orcid":false,"given":"Kyle N.","family":"Kunze","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA"},{"name":"Institute for Cartilage Repair, Hospital for Special Surgery, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Persaud","sequence":"additional","affiliation":[{"name":"Weill Cornell Medical College, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Briano","sequence":"additional","affiliation":[{"name":"Weill Cornell Medical College, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0745-9880","authenticated-orcid":false,"given":"Scott A.","family":"Rodeo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell F.","family":"Warren","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA"},{"name":"Institute for Cartilage Repair, Hospital for Special Surgery, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas L.","family":"Wickiewicz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA"},{"name":"Institute for Cartilage Repair, Hospital for Special Surgery, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2991-7173","authenticated-orcid":false,"suffix":"III","given":"Riley J.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA"},{"name":"Institute for Cartilage Repair, Hospital for Special Surgery, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,1,6]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2016.04.020"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-15-00447"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20230426-01"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.3313"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.11.064"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2019.03.055"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517732531"},{"issue":"6","key":"e_1_3_3_10_2","article-title":"Subchondral drilling for articular cartilage repair: a systematic review of translational research","volume":"11","author":"Gao L","year":"2018","unstructured":"Gao L, Goebel LKH, Orth P, Cucchiarini M, Madry H. 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