Current trends in articular cartilage research: a bibliometric analysis of the 50 most-cited clinical articles over the last 10 years
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20261223Keywords:
Cartilage repair, Bibliometric analysis, Autologous chondrocyte implantation, Mesenchymal stem cells, Osteochondral allograft, Cartilage surgeryAbstract
Articular cartilage lesions are a frequently encountered pathology during arthroscopic procedures and present a significant challenge. The purpose of this study was to conduct a bibliometric analysis to identify the 50 most cited clinical publications on treatments for cartilage surgery from the past decade, providing an updated overview of influential research and emerging trends in treatment strategies. A literature search was performed in October 2025 using the search terms of “cartilage treatment” OR “cartilage surgery” OR “cartilage repair” were used and filtered to include only those published between 2015 through 2025. The 50 most cited articles were identified and independently reviewed by two authors. Methodological quality was assessed using the Modified Coleman Score, and randomized controlled trials (RCTs) were evaluated using the Revised Tool for Risk of Bias in Randomized Trials (RoB 2.0) tool. A total of 21,640 articles were identified in the initial search. The 50 most cited articles were published between January 2015 and January 2021 and had 6407 total citations (mean±standard deviation, 128.1±63.2) (range, 73-366). Study designs of most cited articles included case series (n=26 studies, 52%), RCTs (n=12 studies, 24%), and cohort (n=12 studies, 24%) designs. The mean modified Coleman was 68.0±8.8 (range, 53-85). The journals publishing the most cited articles were the American Journal of Sports Medicine and Cartilage. High-impact cartilage research has shifted toward MSC-based therapies, surpassing ACI/MACI, while overall methodological quality continues to improve.
References
Falah M, Nierenberg G, Soudry M, Hayden M, Volpin G. Treatment of articular cartilage lesions of the knee. Int Orthop. 2010;34(5):621-30.
Mithoefer K. Complex Articular Cartilage Restoration. Sports Med Arthrosc Rev. 2013;21(1):31-7.
Fox AJ, Bedi A, Rodeo SA. The Basic Science of Articular Cartilage: Structure, Composition, and Function. Sports Health. 2009;1(6):461-8.
Davies-Tuck ML, Wluka AE, Wang Y, Teichtahl AJ, Davis SR, Strauss BJ, et al. The natural history of cartilage defects in people with knee osteoarthritis. Osteoarthritis Cartilage. 2008;16(3):337-42.
Mowers CC, Lack BT, Childers JT, Jackson GR. Inconsistencies in clinically significant outcome metrics for knee cartilage repair: a systematic review. Musculoskelet Surg. 2025;109(4):369-80.
Redondo ML, Beer AJ, Yanke AB. Cartilage Restoration: Microfracture and Osteochondral Autograft Transplantation. J Knee Surg. 2018;31(3):231-8.
Park YB, Ha CW, Lee CH, Yoon YC, Park YG. Cartilage Regeneration in Osteoarthritic Patients by a Composite of Allogeneic Umbilical Cord Blood-Derived Mesenchymal Stem Cells and Hyaluronate Hydrogel: Results from a Clinical Trial for Safety and Proof-of-Concept with 7 Years of Extended Follow-Up. Stem Cells Transl Med. 2016;6(2):613-21.
Meyer LE, Hurley ET, Danilkowicz RM, Alaia MJ, Dickens JF, Espregueria‑Mendes J, et al. Concomitant procedures for knee cartilage injuries—an international Delphi consensus statement. J Cartil Joint Preserv. 2024;4(3):100198.
Tan SHS, Kwan YT, Neo WJ, Chong JY, Kuek TYJ, See JZF, et al. Intra-articular injections of mesenchymal stem cells without adjuvant therapies for knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med. 2021;49(11):3113-24.
Familiari F, Shanmugaraj A, Browatzki A, Scheffler SU, Hirschmann MT. Clinical Outcomes and Failure Rates of Osteochondral Allograft Transplantation in the Knee: A Systematic Review. Am J Sports Med. 2017;46(13):3541-9.
Hoffman JK, Geraghty S, Protzman NM. Articular Cartilage Repair Using Marrow Stimulation Augmented with a Viable Chondral Allograft: 9-Month Postoperative Histological Evaluation. Case Rep Orthop. 2015;2015:617365.
Trofa DP, Hong IS, Lopez CD, Rao AJ, Yu Z, Odum SM, et al. Isolated Osteochondral Autograft Versus Allograft Transplantation for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Systematic Review and Meta-analysis. Am J Sports Med. 2023;51(3):812-24.
Dasari SP, Jawanda H, Mameri ES, Fortier LM, Polce EM, Kerzner B, et al. Single-stage autologous cartilage repair results in positive patient-reported outcomes for chondral lesions of the knee: a systematic review. J ISAKOS. 2023;8(5):372-80.
Xie JF, Jackson GR, Childers JT, Lack BT, Mowers CC, DeFroda SF, et al. Variable Return-to-Sport Rates with Improved Pain and Patient-Reported Outcomes Following Osteochondral Allograft Transplantation: A Systematic Review. J Knee Surg. 2025;38(11):563-74.
Kumar LM, George RJ, Anisha PS. Bibliometric analysis for medical research. Indian J Psychol Med. 2023;45(3):277-82.
Lefaivre KA, Shadgan B, O’Brien PJ. 100 most cited articles in orthopaedic surgery. Clin Orthop Relat Res. 2011;469(5):1487-97.
Donthu N, Kumar S, Mukherjee D, Pandey N, Lim WM. How to conduct a bibliometric analysis: an overview and guidelines. J Bus Res. 2021;133:285-96.
Franceschini M, Boffa A, Andriolo L, Di Martino A, Zaffagnini S, Filardo G. The 50 most‑cited clinical articles in cartilage surgery research: a bibliometric analysis. Knee Surg Sports Traumatol Arthrosc. 2022;30(6):1901-14.
Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD. Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Scand J Med Sci Sports. 2000;10(1):2-11.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.
Rosa D, Balato G, Ciaramella G, Soscia E, Improta G, Triassi M. Long‑term clinical results and MRI changes after autologous chondrocyte implantation in the knee of young and active middle‑aged patients. J Orthop Traumatol. 2016;17(1):55-62.
Jaibaji M, Jaibaji R, Volpin A. Mesenchymal stem cells in the treatment of cartilage defects of the knee: a systematic review of the clinical outcomes. Am J Sports Med. 2021;49(13):3716-27.
Gupta PK, Chullikana A, Rengasamy M, Shetty N, Pandey V, Agarwal V, et al. Efficacy and safety of adult human bone marrow-derived, cultured, pooled, allogeneic mesenchymal stromal cells (Stempeucel®): Preclinical and clinical trial in osteoarthritis of the knee joint. Arthritis Res Ther. 2016;18(1):301.
Koh YG, Kwon OR, Kim YS, Choi YJ, Tak DH. Adipose‑derived mesenchymal stem cells with microfracture versus microfracture alone: 2‑year follow‑up of a prospective randomized trial. Arthroscopy. 2016;32(1):97-109.
Christensen BB, Foldager CB, Jensen J, Jensen NC, Lind M. Poor osteochondral repair by a biomimetic collagen scaffold: 1‑ to 3‑year clinical and radiological follow‑up. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2380-7.
Nordberg RC, Bielajew BJ, Takahashi T, Dai S, Hu JC, Athanasiou KA. Recent advancements in cartilage tissue engineering innovation and translation. Nat Rev Rheumatol. 2024;20(6):323-46.
Abu Owida H. Recent Biomimetic Approaches for Articular Cartilage Tissue Engineering and Their Clinical Applications: Narrative Review of the Literature. Adv Orthop. 2022;2022:8670174.
Brittberg M, Recker D, Ilgenfritz J, Saris DBF. Matrix‑applied characterized autologous cultured chondrocytes versus microfracture: five‑year follow‑up of a prospective randomized trial. Am J Sports Med. 2018;46(6):1343-51.
Mumme M, Barbero A, Miot S, Wixmerten A, Feliciano S, Wolf F, et al. Nasal chondrocyte-based engineered autologous cartilage tissue for repair of articular cartilage defects: an observational first-in-human trial. Lancet. 2016;388(10055):1985-94.
Lu L, Zhang Z, Yu X, Qiao Z, Shi D, Zhao B, et al. Treatment of knee osteoarthritis with intra‑articular injection of autologous adipose‑derived mesenchymal progenitor cells: a prospective, randomized, double‑blind, active‑controlled, phase IIb clinical trial. Stem Cell Res Ther. 2019;10(1):143.
Knutsen G, Drogset JO, Engebretsen L, Grøntvedt T, Ludvigsen TC, Løken S, et al. A Randomized Multicenter Trial Comparing Autologous Chondrocyte Implantation with Microfracture: Long-Term Follow-up at 14 to 15 Years. J Bone Joint Surg Am. 2016;98(16):1332-9.
De Windt TS, Vonk LA, Slaper‑Cortenbach ICM, Van den Broek MPH, Nizak R, Van Rijen MHP, et al. Allogeneic Mesenchymal Stem Cells Stimulate Cartilage Regeneration and Are Safe for Single-Stage Cartilage Repair in Humans upon Mixture with Recycled Autologous Chondrons. Stem Cells. 2017;35(1):256-64.
Sekiya I, Muneta T, Horie M, Koga H. Arthroscopic transplantation of synovial stem cells improves clinical outcomes in knees with cartilage defects. Clin Orthop Relat Res. 2015;473(7):2316-26.
Gobbi A, Whyte GP. One‑stage cartilage repair using a hyaluronic acid‑based scaffold with activated bone marrow‑derived mesenchymal stem cells compared with microfracture. Am J Sports Med. 2016;44(11):2846-54.
Davatchi F, Sadeghi Abdollahi B, Mohyeddin M, Nikbin B. Mesenchymal stem cell therapy for knee osteoarthritis: 5‑year follow‑up of three patients. Int J Rheum Dis. 2016;19(2):219-25.
Gobbi A, Chaurasia S, Karnatzikos G, Nakamura N. Matrix‑induced autologous chondrocyte implantation versus multipotent stem cells for the treatment of large patellofemoral chondral lesions: a nonrandomized prospective trial. Cartilage. 2015;6(2):82-97.
Soler R, Orozco L, Munar A, Baguena M, Sánchez A, Garcia‑Sánchez V, et al. Final results of a phase I‑II trial using ex vivo expanded autologous mesenchymal stromal cells for the treatment of osteoarthritis of the knee confirming safety and suggesting cartilage regeneration. Knee. 2016;23(4):647-54.
Jiang Y, Tuan RS. Human cartilage‑derived progenitor cells from committed chondrocytes for efficient cartilage repair and regeneration. Stem Cells Transl Med. 2016;5(6):733-44.
Shive MS, Demange MK, Nunes GS, Palmer MP, Xu A, Farr J, et al. BST‑CarGel® treatment maintains cartilage repair superiority over microfracture at 5 years in a multicenter randomized controlled trial. Cartilage. 2015;6(1):62-72.
Volz M, Schaumburger J, Frick H, Grifka J, Anders S. A randomized controlled trial demonstrating sustained benefit of autologous matrix‑induced chondrogenesis over microfracture at five years. Int Orthop. 2017;41(4):797-804.
Hong Z, Guo X, He Y, Song Y, Cao J, Li X, et al. Intra‑articular injection of autologous adipose‑derived stromal vascular fractions for knee osteoarthritis: a double‑blind randomized self‑controlled trial. Int Orthop. 2019;43(5):1123-34.
Frank RM, Lee S, Bush‑Jacobson S, Cotter EJ, Strauss EJ, McCarty EC,, et al. Osteochondral allograft transplantation of the knee: analysis of failures at 5 years. Am J Sports Med. 2017;45(4):864-74.
Solheim E, Hegna J, Strand T, Harlem T, Inderhaug E. Randomized study of long‑term (15–17 years) outcome after microfracture versus mosaicplasty in knee articular cartilage defects. Am J Sports Med. 2018;46(4):826-31.
De Windt TS, Vonk LA, Slaper‑Cortenbach ICM, Van den Broek MPH, Nizak R, Van Rijen MHP, et al. Allogeneic MSCs and Recycled Autologous Chondrons Mixed in a One-Stage Cartilage Cell Transplantion: A First-in-Man Trial in 35 Patients. Stem Cells. 2017;35(8):1984-93.
Gobbi A, Bhupal S, Karnatzikos G, Lanzi JT. One‑step surgery with multipotent stem cells and hyaluronan‑based scaffold for the treatment of full‑thickness chondral defects of the knee in patients older than 45 years. Knee Surg Sports Traumatol Arthrosc. 2017;25(8):2494-501.
Ogura T, Mosier BA, Bryant T, Minas T. A 20‑year follow‑up after first‑generation autologous chondrocyte implantation. Am J Sports Med. 2017;45(12):2751-61.
Kim YS, Koh YG, Choi YJ, Kwon OR, Tak DH. Comparative matched‑pair analysis of the injection versus implantation of mesenchymal stem cells for knee osteoarthritis. Am J Sports Med. 2015;43(11):2738-46.
Sato M, Yamato M, Mitani G, Takagaki T, Hamahashi K, Nakamura Y, et al. Combined surgery and chondrocyte cell-sheet transplantation improves clinical and structural outcomes in knee osteoarthritis. NPJ Regen Med. 2019;4:4.
Kim MK, Ha CW, In Y, Cho SD, Choi ES, Ha JK, et al. A Multicenter, Double-Blind, Phase III Clinical Trial to Evaluate the Efficacy and Safety of a Cell and Gene Therapy in Knee Osteoarthritis Patients. Hum Gene Ther Clin Dev. 2018;29(1):48-59.
Hannon CP, Ross KA, Crum RJ, Abouljoud MM, Clarke MT, Murawski CD, et al. Arthroscopic bone marrow stimulation and concentrated bone marrow aspirate for osteochondral lesions of the talus: a case‑control study of functional and magnetic resonance observation of cartilage repair tissue outcomes. Arthroscopy. 2016;32(2):339-47.
Gracitelli GC, Meric G, Pulido PA, Bugbee WD. Fresh osteochondral allografts in the knee: comparison of primary transplantation versus transplantation after failure of previous subchondral marrow stimulation. Am J Sports Med. 2015;43(4):885-91.
Enea D, Vannini F, Cavallo M, Grigolo B, Facchini A. One‑step cartilage repair in the knee: collagen‑covered microfracture and autologous bone marrow concentrate — a pilot study. Knee. 2015;22(1):30-5.
Salonen EE, Nieminen MT, Koivikko MP, Parviainen MT, Kallio PE. Traumatic patellar dislocation and cartilage injury: a follow‑up study of long‑term cartilage deterioration. Am J Sports Med. 2017;45(6):1376-82.
Massen FK, Maldonado DR, Chen J, Klatt BA, Ferrer MG, Williams RJ , et al. One‑step autologous minced cartilage procedure for the treatment of knee joint chondral and osteochondral lesions: a series of 27 patients with 2‑year follow‑up. Orthop J Sports Med. 2019;7(11):2325967119853773.
Nielsen ES, McCauley JC, Pulido PA, Bugbee WD. Return to sport and recreational activity after osteochondral allograft transplantation in the knee. Am J Sports Med. 2017;45(7):1608-14.
Ebert JR, Fallon M, Wood DJ, Janes GC. A prospective clinical and radiological evaluation at 5 years after arthroscopic matrix‑induced autologous chondrocyte implantation. Am J Sports Med. 2017;45(1):59-69.
Kim YS, Koh YG, Choi YJ, Kwon OR, Tak DH. Assessment of clinical and MRI outcomes after mesenchymal stem cell implantation in patients with knee osteoarthritis: a prospective study. Osteoarthritis Cartilage. 2016;24(2):237-45.
Fontana A, De Girolamo L. Sustained five‑year benefit of autologous matrix‑induced chondrogenesis for femoral acetabular impingement‑induced chondral lesions compared with microfracture treatment. Bone Joint J. 2015;97(5):628-35.
Spasovski D, Spasovski V, Baščarević Z, Stojiljković M, Vreća M, Anđelković M, et al. Intra-articular injection of autologous adipose-derived mesenchymal stem cells in the treatment of knee osteoarthritis. J Gene Med. 2018;20(1):e3002.
Gobbi A, Whyte GP. Long‑term clinical outcomes of one‑stage cartilage repair in the knee with hyaluronic acid‑based scaffold embedded with mesenchymal stem cells sourced from bone marrow aspirate concentrate. Am J Sports Med. 2019;47(7):1621-8.
Hashimoto Y, Nishida Y, Takahashi S, Nakamura H, Mera H, Kashiwa K, et al. Transplantation of autologous bone marrow-derived mesenchymal stem cells under arthroscopic surgery with microfracture versus microfracture alone for articular cartilage lesions in the knee: A multicenter prospective randomized control clinical trial. Regen Ther. 2019;11:106-13.
Gille J, Behrens P, Schulz AP, Oheim R, Kienast B. Matrix‑associated autologous chondrocyte implantation: a clinical follow‑up at 15 years. Cartilage. 2016;7(4):309-15.
Gracitelli GC, Meric G, Pulido PA, McCauley JC, Bugbee WD. Osteochondral allograft transplantation for knee lesions after failure of cartilage repair surgery. Cartilage. 2015;6(1):98-105.
Briggs DT, Sadr KN, Pulido PA, Bugbee WD. The use of osteochondral allograft transplantation for primary treatment of cartilage lesions in the knee. Cartilage. 2015;6(2):203-7.
Basad E, Wissing FR, Fehrenbach P, Rickert M, Steinmeyer J, Ishaque B. Matrix‑induced autologous chondrocyte implantation (MACI) in the knee: clinical outcomes and challenges. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3729-35.
Niemeyer P, Laute V, Zinser W, Becher C, Kolombe T, Fay J, et al. A Prospective, Randomized, Open-Label, Multicenter, Phase III Noninferiority Trial to Compare the Clinical Efficacy of Matrix-Associated Autologous Chondrocyte Implantation With Spheroid Technology Versus Arthroscopic Microfracture for Cartilage Defects o. Orthop J Sports Med. 2019;7(7):2325967119854442.
Kubosch EJ, Bode G, Südkamp NP, Niemeyer P. Clinical outcome and T2 assessment following autologous matrix‑induced chondrogenesis in osteochondral lesions of the talus. Int Orthop. 2016;40(1):65-71.
Ogura T, Ackermann J, Mestriner AB, Merkely G, Gomoll AH. The minimal clinically important difference and substantial clinical benefit in the patient‑reported outcome measures of patients undergoing osteochondral allograft transplantation in the knee. Cartilage. 2021;12(1):42-50.
Lim HC, Park YB, Ha CW, Lee CH, Yoon YC, Jung J, et al. Allogeneic umbilical cord blood‑derived mesenchymal stem cell implantation versus microfracture for large, full‑thickness cartilage defects in older patients: a multicenter randomized clinical trial and extended 5‑year clinical follow‑up. Orthop J Sports Med. 2021;9(9):2325967120973052.
Solheim E, Hegna J, Inderhaug E. Long‑term survival after microfracture and mosaicplasty for knee articular cartilage repair: a comparative study between two treatment cohorts. Cartilage. 2020;11(1):71-6.
Chahal J, Lansdown DA, Davey A, Davis AM, Cole BJ. The clinically important difference and patient acceptable symptomatic state for commonly used patient‑reported outcomes after knee cartilage repair. Am J Sports Med. 2021;49(1):193-9.
Shimomura K, Muneta T, Morito T, Matsumoto K, Tsuji K, Saito H, et al. First‑in‑human pilot study of implantation of a scaffold‑free tissue‑engineered construct generated from autologous synovial mesenchymal stem cells for repair of knee chondral lesions. Am J Sports Med. 2018;46(10):2384-93.
Downloads
Published
How to Cite
Issue
Section
