Introduction

There is a noteworthy difference between the breadth and depth of data on cartilage repair techniques and their clinical use. Despite more than three decades of accumulated supporting information, most cartilage repair options are still rarely encountered outside the specialized community.

Content

One reason for this are the problems associated with navigating the data to chose an appropriate treatment for the patient at hand. In order to facilitate this process, individual data points are being assembled to evidence, as seen in the prior talks in the session. This evidence can be thought of as the “map to cartilage repair”

However, true to this analogy, a map alone is of little use if one does not know the present position, the destination, headings et cetera. Adding such extra information, such as cost-effectiveness, access and availability, timing, interest of other stakeholders, to the baseline evidence allows creating clinical guidelines.

Before discussing guidelines in cartilage repair, both the need for and the process of formulating and supporting clinical guidelines are worthwhile critical appraisal. Not all guidelines are created equal and not all guidelines are being employed within the scope of the intended use. A general understanding of guideline development processes, including pitfalls and shortcomings, is a valuable tool for present day clinicians.

Guidelines for cartilage repair have been brought forward by scientific societies, public bodies, and insurance companies. These guidelines arrive at a general consensus that cartilage repair, particularly autologous chondrocyte implantation ACI over mosaicplasty and/or microfracture, is an effective and cost-effective treatment option for a defined population. Shortcomings exist: Treatment effectiveness outside of this narrowly defined population is not commented on. Estimates on cost and utility are presented, but obviously highly dependent on geographic location. The dissemination of guidelines is incomplete. The extent to which these guidelines influence health care policy remains unknown.

In summary, guideslines are valuable tools for clinical decision making and to direct clinicians in choosing cartilage repair options. However, their applicability is limited to the scope of the studied populations and dependent on quality and consistency of the primary data. Deduction and extrapolations beyond this scope are not warranted, but research in uncharted new techniques is.