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    Interventional procedure overview of focal resurfacing implants to treat articular cartilage damage in the knee

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    Efficacy summary

    Patient-reported outcomes

    KOOS

    A systematic review and meta-analysis of 127 people (before surgery) and 90 people (after surgery) found statistically significant improvements in each subscale of the KOOS instrument at 2 years follow up compared with before surgery (Elbardesy, 2021):

    • Pain: standardised mean difference was -5.61 (95% CI -8.11 to -3.11), showing lower pain after surgery.

    • Symptoms: standardised mean difference was -4.96 (95% CI -7.28 to -2.63), showing lesser symptoms after surgery.

    • Activities of daily living: standardised mean difference was -5.08 (95% CI -7.40 to -2.76), showing less difficulty doing activities of daily living after surgery.

    • Sport and recreational activities: standardised mean difference was -4.35 (95% CI -7.08 to -1.61), showing less difficulty doing sports and recreational activities.

    • Quality of life: standardised mean difference was -4.35 (95% CI -7.08 to -1.61), showing less difficulty doing sports and recreational activities.

    In a retrospective cohort study of 118 people, there were statistically significant improvements in KOOS QoL in people who had BioPoly (difference 29.96; p<0.001) and in people who had HemiCAP (difference 32.41; p<0.001) from before surgery to 2 years after surgery. In a comparative analysis, there was no difference in the change in KOOS QoL between people who had HemiCAP and people who had BioPoly (p=0.150) (Çepni, 2020).

    In a before-and-after study of 33 people, there was a statistically significant increase in KOOS overall from 44.9 (plus or minus 18.0) before surgery to 77.6 (plus or minus 16.6) at 2 years after surgery (p<0.025). There were also statistically significant increases in KOOS overall (and component subscale scores) at 6 months, 1 year, and 2 years (all p<0.025) (Nathwani, 2017).

    In a before-and-after study of 75 people, there were statistically significant changes from baseline in each subscale of KOOS to 2 years after surgery (Holz, 2021):

    • KOOS-Pain: change = 26.28 (95% CI 19.86 to 32.70; p<0.0001)

    • KOOS-Symptoms: change = 18.30 (95% CI 12.70 to 23.90; p<0.0001)

    • KOOS-ADL: change = 22.75 (95% CI 16.42 to 29.09; p<0.0001)

    • KOOS-Sport: change = 25.27 (95% CI 17.04 to 33.50; p<0.0001)

    • KOOS-QoL: change = 25.26 (95% CI 18.14 to 32.37; p<0.0001)

    WOMAC

    In a before-and-after study of 132 people, there was a statistically significant increase in WOMAC score from 75.3 (plus or minus 2.3) before surgery to 87.3 (plus or minus 6.6) at 4 years after surgery (p<0.001) (van Buul, 2021).

    Tegner Activity Scale

    In a retrospective cohort study of 118 people, there were statistically significant increases in Tegner Activity Scale scores in people who had BioPoly (difference 1.22; p<0.001) and in people who had HemiCAP (difference 1.30; p<0.001) from before surgery to 2 years after surgery. In a comparative analysis, people who had HemiCAP had a statistically significantly greater improvement in Tegner Activity Scale score than people who had BioPoly (p<0.001) (Çepni, 2020).

    In the before-and-after study of 33 people, there was a statistically significant increase in Tegner Activity Scale score from 2.5 (plus or minus 1.7) before surgery to 4.0 (plus or minus 1.9) at 2 years after surgery (p<0.025) (Nathwani, 2017).

    VAS pain

    In a retrospective cohort study of 118 people, there were statistically significant decreases in VAS pain scores in people who had BioPoly (difference -4.60; p<0.001) and in people who had HemiCAP (difference -5.99; p<0.001) from before surgery to 2 years after surgery. In a comparative analysis, people who had HemiCAP experienced a statistically significantly greater improvement in VAS pain score than people who had BioPoly (p<0.001). People who had HemiCAP had statistically significantly higher VAS pain score before surgery than people who had BioPoly (Çepni, 2020).

    In the before-and-after study of 33 people, there was a statistically significant decrease in VAS pain score from 4.1 (plus or minus 2.5) before surgery to 1.4 (plus or minus 2.2) at 2 years after surgery (p<0.025) (Nathwani, 2017).

    In the before-and-after study of 75 people, there was a statistically significant change in VAS pain score of 30.22 (95% CI 22.34 to 38.11) from before surgery to 2 years follow up (Holz, 2021).

    SF-36

    In the before-and-after study of 33 people, there was a statistically significant increase in SF-36 physical component scores from 42.3 (plus or minus 32.0) before surgery to 81.9 (plus or minus 30.8) at 2 years after surgery (p<0.025) (Nathwani, 2017).