Mithoefer, K., McAdams, T., Williams, R., Kreuz, P. and Mandelbaum, B. American Journal of Sports Medicine; 2009, 37, 2053 – 2063.
http://www.ncbi.nlm.nih.gov/pubmed/19251676
Cartilage injuries affect a substantial part of patients who suffered knee trauma. Limited regenerative capabilities of articular cartilage makes treatment approach complicated and challenging. Several surgical procedures are currently available for clinicians including microfracture, autologous chondrocyte implantation, and osteochondral autograft and allograft transplantation. The arthroscopic microfracture technique is commonly used as a first-line option and frequently serves as the standard technique. Despite its widespread clinical use, no systematic evaluation of the clinical efficacy of the microfracture technique for cartilage repair in the knee is available. Thus, authors performed a comprehensive systematic analysis of the microfracture procedure with specific focus on its short and long-term clinical results.
Twenty-eight studies were included, describing 3122 patients. The average postoperative follow-up was 41 ± 5 months. The average postoperative Lysholm score was 80.8 ± 6 and the average Tegner score was 4.8 ± 0.8 at the time of last follow-up. Improvement was reported as early as 6 months, with the greatest overall improvement consistently occurring during the first 24 months after microfracture. Improved knee function was reported in 67% to 86% of patients at an average of 6 to 7 years after microfracture, with pain and swelling being the parameter with the greatest improvement. Two studies reported that the initial functional improvement observed during the first 2 years after microfracture was maintained. In contrast, 7 studies reported deterioration of initial functional improvement in 47% to 80% of patients between 18 and 36 months after microfracture. Younger age resulted in better clinical outcome scores and better repair cartilage fill on MRI. Microfracture was most effective as a firstline procedure. Patients with lesions <4 cm2 had better knee function scores. Higher body mass index was associated with worse knee function and repair cartilage volume. Repair cartilage fill on MRI was better with age <40 years, femoral condyle lesions, smaller defect size and lower body mass index. Authors concluded that microfracture provides effective short-term functional improvement of knee function but insufficient data are available on its long-term results.
What are your experiences with patients
treated with microfracture? Do you have any specific recommendations on how to
lead those patients ?
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