Review Surgical treatments of cartilage defects of the knee: Systematic review of randomised controlled trials Brian M Devitt a, ⁎ ,1 , Stuart W Bell a,1 , Kate E Webster b , Julian A Feller a,b , Tim S Whitehead a a OrthoSport Victoria, Richmond, Australia b School of Allied Health, La Trobe University, Melbourne, Australia article info abstract Article history: Received 22 May 2016 Received in revised form 24 November 2016 Accepted 7 December 2016 Available online xxxx Background: The aim of this systematic review was to identify high quality randomised controlled trials (RCTs) and to provide an update on the most appropriate surgical treatments for knee cartilage defects. Methods: Two reviewers independently searched three databases for RCTs comparing at least two different treatment techniques for knee cartilage defects. The search strategy used terms mapped to relevant subject headings of MeSH terms. Strict inclusion and exclusion criteria were used to iden- tify studies with patients aged between 18 and 55 years with articular cartilage defects sized be- tween one and 15 cm 2 . Risk of bias was performed using a Coleman Methodology Score. Data extracted included patient demographics, defect characteristics, clinical outcomes, and failure rates. Results: Ten articles were included (861 patients). Eight studies compared microfracture to other treatment; four to autologous chondrocyte implantation (ACI) or matrix-induced ACI (MACI); three to osteochondral autologous transplantation (OAT); and one to BST-Cargel. Two studies report- ed better results with OAT than with microfracture and one reported similar results. Two studies re- ported superior results with cartilage regenerative techniques than with microfracture, and two reported similar results. At 10 years significantly more failures occurred with microfracture com- pared to OAT and with OAT compared to ACI. Larger lesions (> 4.5 cm 2 ) treated with cartilage regen- erative techniques (ACI/MACI) had better outcomes than with microfracture. Conclusions: Based on the evidence from this systematic review no single treatment can be recom- mended for the treatment of knee cartilage defects. This highlights the need for further RCTs, preferably patient-blinded, using an appropriate reference treatment or a placebo procedure. © 2016 Elsevier B.V. All rights reserved. Keywords: Knee Cartilage defects Systematic review Microfracture ACI MACI OAT Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2.1. Search strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2.2. Selection criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2.3. Risk of bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2.4. Data extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 The Knee xxx (2016) xxx–xxx ⁎ Corresponding author at: Orthosport Victoria, Epworth Hospital Richmond, Vic 3121, Australia. E-mail addresses: bdevitt@osv.com.au (B.M. Devitt), drstuartbell@gmail.com (S.W. Bell), k.webster@latrobe.edu.au (K.E. Webster), jfeller@osv.com.au (J.A. Feller), tswhitehead@osv.com.au (T.S. Whitehead). 1 Co-first authors. THEKNE-02388; No of Pages 10 http://dx.doi.org/10.1016/j.knee.2016.12.002 0968-0160/© 2016 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect The Knee Please cite this article as: Devitt BM, et al, Surgical treatments of cartilage defects of the knee: Systematic review of randomised controlled trials, Knee (2016), http://dx.doi.org/10.1016/j.knee.2016.12.002