Outcomes and Quality of Evidence of the Treatment of Upper Extremity Cartilage Injuries: A Systematic Review.

Background: Cartilage injuries of the hand, wrist and elbow are common and may be managed by a variety of established procedures. While much literature has been devoted to cartilage injuries in the joints of the lower extremity, what data is available regarding treatment of similar injuries in the upper extremity is unknown. This systematic review assesses current procedures utilised to treat isolated cartilage injuries in the upper extremity and their outcomes. Methods: A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed/MEDLINE was searched to identify articles that reported on cartilage procedures of the hand, wrist or elbow. Study demographic information, type of procedure and clinical outcomes (patient-reported outcome measures [PROMs], radiographic measures, return to play [if applicable], complications and follow-up) were collected and reported. Results: The initial search yielded 532 articles. Of these, 118 articles underwent full-text review; 47 articles were ultimately included and analysed. The majority of articles were Level IV evidence and reported on osteochondral autograft transplantation (OATS) in the elbow and hand. The remaining articles for the elbow reported on arthroscopic debridement with microfracture or drilling, arthroscopic debridement alone and core decompression. The remaining articles for the wrist reported on autologous chondrocyte implantation and arthroscopy. One hand article reported on periosteal autografting. Conclusions: The most significant improvements in PROMs, range of motion and return to play were reported for OATS procedures of the elbow, wrist and hand. Studies of a higher level of evidence are important to further standardise the treatment of cartilage injuries of the upper extremity. Level of Evidence: Level III (Therapeutic).