The news release focuses on a small-scale study comparing the outcomes of osteochondral allograft transplantation — a technique that replaces damaged knee cartilage with healthy cartilage from a donor. The researchers used the technique to treat knee pain in two groups of patients: those over the age of forty and those under the age of forty. Specifically, the release reports that osteochondral allograft transplantation — sometimes in conjunction with additional surgery — can be an effective treatment for older adults. However, the release offers little detailed information. For example, it fails to address costs, potential harms, or quantified benefits related to the procedure. It also didn’t explain that the control group used in the study wasn’t really adequate to demonstrate the effectiveness of the procedure.
Knee pain is a common complaint that increases with age. In older individuals, symptoms are often related to arthritis due to “wear and tear” over time. Problems with the cartilage that covers the bone are thought to be a common factor that contributes to these arthritic changes. If the cartilage is lost in certain places, the result is bone on bone irritation without the protective surface that the cartilage provides. There are many causes for developing cartilage defects, but one is prior knee surgery, commonly arthroscopic (“scope”) procedures done to repair tears in the pad (meniscus) that cushion the knee bones. That is why most patients in this study had a history of prior surgery. Treatment for cartilage damage has focused on ways to regrow it so that the defects can be repaired. This study reports on one such procedure. The key issue evaluated here is the age of the patient. This is important because with increasing age the cartilage problems get worse and don’t respond to repair attempts. So studies demonstrating similar benefit in older compared to younger patients may be important. But it is also important to know that even in younger patients, such techniques haven’t been shown in high quality studies to really work, especially in longer-term follow-up studies. Thus saying that outcomes were similar in younger and older patients may mislead readers by overlooking the generally limited evidence of success, especially over time, in younger patients.
Costs are not addressed at all. A 2007 article from Orthopedics Today estimated the cost of an allograft at approximately $10,000. The relevant cost may have gone up or down in the intervening years, but is likely still considerable — and well worth mentioning.
Benefits are not quantified at all. The release refers only to “statistically significant improvement” for IKDC and “all five KOOS sub-scores.” The release does not tell readers what “statistically significant improvement” means, nor do they explain what IKDC or KOOS stand for — much less what the various sub-scores are. We assume from the language in the release that it is intended largely for an expert audience. However, news releases are ultimately aimed at reporters — that’s what makes them news releases. While some reporters may be familiar with IKDC or KOOS, many reporters (even very good ones) are not. It would be more than worthwhile to include a few additional sentences articulating what the scores are, what the relevant numerical benefits were, and why the researchers deemed the changes in these scores to be important.
Potential harms are not discussed at all. No surgery is completely without risks, so this is not an acceptable oversight. For example, as of 2007, Orthopedics Today was still highlighting the fact that “Disease transmission also remains a worry for surgeons using allografts.”
The release is so concise, we aren’t really sure what is being done. It appears that the genesis of the study is that this procedure works in younger patients and now the question is whether it works in older ones. But as noted above, the effectiveness of this procedure in younger patients hasn’t been conclusively demonstrated. So the control group of younger patients is problematic for making comparisons. Also left out is the real question of whether this treatment in older patients results in better outcomes compared to a sham or placebo treatment or another active treatment. That would be the control group that could allow for a meaningful assessment of benefit. For all intents and purposes, there is no real control group of similar patients (based upon age here) who were randomly assigned to receive a different treatment.
Another problem is that the release misstates the number of patients involved. The release refers to 80 patients — 38 in the study group and 42 in the control group. The abstract for the relevant study says that there were 33 patients in the study group and 35 in the control group, for a total of 68 patients. A difference of 12 patients may not be hugely significant in a large study, but a cohort of 68 patients is 15 percent smaller than a cohort of 80. It’s problematic to make a mistake on a point as basic as this one.
There was no disease mongering. However, the story also doesn’t provide any context on what this procedure is supposed to treat or the impact of that condition. We’ll rate this Not Applicable.
The release does not say how the research was funded, nor does it address conflicts of interest. To be clear, the research may have been internally funded, and there may well be no conflicts of interest — but it’s important for a release to state that explicitly.
Other techniques for addressing knee pain, including oral medications, injectable medications, physical therapy, and other surgical treatment options, are not mentioned. It is not clear from the release how or why osteochondral allograft transplantation may be more advantageous than other options.
The release notes that “osteochondral allograft transplantation has traditionally been used in younger active patients with cartilage disorders.” Readers can infer from this that the technique is already available, although it may not be available everywhere and not all insurers will cover these procedures.
There are dozens, if not hundreds, of journal articles out there regarding the use of osteochondral allograft transplantation to address knee problems. What sets this one apart? Presumably it is the first to directly compare outcomes between older and younger adults, but the release doesn’t explicitly tell readers that.
The release is very careful to use cautious language, such as noting in the headline that “older patients with knee pain may benefit” [emphasis added] from the relevant treatment technique.