Arthroscopy - 2026-07-19 - Journal Article; Review
Concomitant Procedures Around Cartilage Restoration Surgery Is Associated With Improved Outcomes and Decreased Failure Rates: A Systematic Review.
Meyer LE, Bethell MA, Hurley ET, Villarreal-Espinosa JB, Sherman SL, Amendola A, Toth AP
Topics
Key Takeaway
Concomitant osteotomy with cartilage restoration reduces failure rates to 0–10.5% compared to 0–41.7% for cartilage restoration alone across 1,783 knees.
Summary Depth
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Summary
This systematic review evaluated whether concomitant osteotomy or meniscal allograft transplantation (MAT) affects outcomes in cartilage restoration surgery. Across 40 studies and 1,783 knees, osteotomy combined with cartilage restoration yielded failure rates of 0–10.5% versus 0–41.7% for cartilage restoration alone; MAT combined with cartilage restoration improved Lysholm scores from a preoperative range of 41.9–70.6 to 63.6–88.0 and IKDC scores from 32.9–45.5 to 55.3–76.0. MAT failure rates (14.0–15.2%) were comparable to cartilage restoration alone (12.1–14.0%), suggesting no additive harm from combining procedures.
Key Limitation
The extreme heterogeneity (up to 98%) across included Level II–IV studies prevents any pooled statistical comparison, meaning all failure rate and outcome differences are descriptive and potentially confounded by variable patient selection, graft type, and lesion characteristics.
Original Abstract
PURPOSE
To evaluate the current literature to determine the impact of concomitant alignment or meniscal surgery on outcomes in patients undergoing cartilage restoration surgery.
METHODS
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.
RESULTS
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%.
CONCLUSIONS
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 OF EVIDENCE
Level IV, systematic review of Level II, III, and IV studies.