Rising Use of Reconstructive Cartilage Procedures of the Knee With Persistently Low Surgical Complication Rates Based on the American College of Surgeons National Surgical Quality Improvement Program

Purpose To determine current treatments used for chondral defects of the knee, to analyze complications, and to identify risk factors for adverse events. Methods In this retrospective database study, the American College of Surgeons National Surgery Quality Improvement Program database (2010‐2023) was searched using Current Procedural Terminology codes for arthroscopic osteochondral allograft, arthroscopic osteochondral autograft (aOAT), autologous chondrocyte implantation, open osteochondral allograft, open osteochondral autograft, chondroplasty, and microfracture and compared via linear regression. Exclusion criteria included any patients with unknown or null values for sex, body mass index, functional status, American Society of Anesthesiologists classification, operative time, anesthesia technique, or total length of hospital stay at the time of surgery. There was no minimum follow‐up time required for inclusion. Concomitant procedures, adverse outcomes, and various demographic factors were then quantified in the setting of previously stated surgery techniques. Totals were stratified against each group for significance. Results The number of patients who met the inclusion criteria was 23,190 (51.3% men). Chondroplasty was the most performed procedure. There were significant increases in the use rates of aOAT ( P = .011), autologous chondrocyte implantation ( P < .001), open osteochondral allograft ( P < .001), and arthroscopic osteochondral allograft ( P < .001) throughout the course of the study. No significant increases in chondroplasty or open osteochondral autograft were observed. Open osteochondral allograft had the highest complication rate of 3.74%, whereas the lowest was seen in microfracture at 1.55%. When comparing surgical methods, any adverse event occurred more often in chondroplasty (2.23%) (relative risk: 1.44; 95% confidence interval [1.13‐1.83]; P = .037) and aOAT (3.60%) (relative risk: 2.33; 95% confidence interval [1.37‐3.95]; P = .037) compared with microfracture (1.54%). Meniscectomy was the most performed concomitant procedure, especially in the setting of microfracture (40%). Conclusions Cartilage reconstructive procedures of the knee continue to increase in use, especially alongside other procedures concomitantly. Complication rates remain low for all techniques, although there are significant differences in adverse events when comparing chondroplasty and aOAT to microfracture, with microfracture having fewer complications. Level of Evidence Level IV, therapeutic retrospective study.