Advertisement

Arthroscopic microfracture of chondral defects of the knee: A comparison of two postoperative treatments

      Purpose: We hypothesized that the treatment of focal, full-thickness chondral defects by an identical method of arthroscopic microfracture but with different postoperative regimens would produce similar results. Type of Study: Case control study, retrospective cohort. Methods: Fifty patients treated over a 6-year period (1993 to 1999) with a focal, less than 2-cm2, full-thickness chondral defect of either the medial or lateral femoral condyle of the knee had arthroscopic surgery to debride loose adjacent cartilage flaps and abortive fibrocartilage from the crater in conjunction with microfracture of the subchondral plate using a hand awl. Postoperatively, 1 group was treated with non-weight bearing and continuous passive motion (CPM) for 6 weeks (group I), and the other group was allowed weight bearing as tolerated and did not use CPM (group II). Results of treatment were assessed by the Lysholm knee rating scale augmented by the Tegner method of activity evaluation. Results were analyzed by independent t test or χ-square test with significance assumed for P < .05. Results: Forty-three of 50 patients were evaluated at a minimum of 2 years after surgery (mean, 4.2 years; range, 2 to 9 years). The mean age was 39.7 years (range, 16 to 66 years) and there were 19 female and 24 male patients. For group I, Lysholm scores were 37 preoperative, 81 postoperative, and Tegner scores were 3 and 6, respectively. Group II Lysholm scores were 33 preoperative, 85 postoperative, and Tegner scores 3 and 6, respectively. No significant differences between groups were noted. Conclusions: In relatively small full-thickness chondral defects of the femoral condyles treated by microfracture, this study found no differences in results comparing 2 rehabilitation regimens differing by weight-bearing status and use of CPM. Level of Evidence: Level III, Case Control Study.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Curl W.W.
        • Krome J.
        • Gordon E.S.
        • Rushing J.
        • Patterson-Smith B.
        • Poehling G.G.
        Cartilage injuries.
        Arthroscopy. 1997; 13: 456-460
        • Outerbridge R.E.
        The etiology of chondromalacia patella.
        J Bone Joint Surg Br. 1961; 43: 752-757
        • Hjelle K.
        • Solheim E.
        • Strand T.
        • Muri R.
        • Brittberg M.
        Articular cartilage defects in 1,000 knee arthroscopies.
        Arthroscopy. 2002; 18: 730-734
        • Hunter W.
        On the structure and diseases of articulating cartilages.
        Philos Trans R Soc. 1993; 42: 514-521
        • Mankin H.J.
        The response of articular cartilage to mechanical injury.
        J Bone Joint Surg Am. 1982; 64: 460-466
        • Messner K.
        • Maletius W.
        The long-term prognosis for severe damage to weight-bearing cartilage in the knee.
        Acta Orthop Scand. 1996; 67: 165-168
        • Salter R.B.
        • Simmonds D.F.
        • Malcolm B.W.
        • Rumble E.J.
        • MacMichael D.
        • Clements N.D.
        The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit.
        J Bone Joint Surg Am. 1980; 62: 1232-1251
        • Kim H.K.
        • Moran M.E.
        • Salter R.B.
        The potential for regeneration of articular cartilage in defects created by chondral shaving and subchondral abrasion. An experimental investigation in rabbits.
        J Bone Joint Surg Am. 1991; 73: 1301-1315
        • O’Driscoll S.W.
        • Keeley F.W.
        • Salter R.B.
        Durability of regenerated articular cartilage produced by free autogenous periosteal grafts in major full-thickness defects in joint surfaces under the influence of continuous passive motion. A follow-up report at one year.
        J Bone Joint Surg Am. 1988; 70: 595-606
        • Rodrigo J.J.
        • Steadman J.R.
        • Silliman J.F.
        • Fulstone H.A.
        Improvement of full-thickness chondral defect healing in the human knee after debridement and microfracture using continuous passive motion.
        Am J Knee Surg. 1994; 7: 109-116
        • Hunt N.
        • Sanchez-Ballister J.
        • Pandit R.
        • Thomas R.
        • Strachan R.
        Chondral lesions of the knee.
        Arthroscopy. 2001; 17: 481-490
        • Noyes F.R.
        • Stabler C.L.
        A system for grading articular cartilage lesions at arthroscopy.
        Am J Sports Med. 1989; 17: 505-513
        • Sgaglione N.A.
        • Del Pizzo W.
        • Fox J.M.
        • Friedman M.J.
        Critical analysis of knee ligament rating systems.
        Am J Sports Med. 1995; 23: 660-667
        • Horas U.
        • Pelinkovic D.
        • Herr G.
        • Aigner T.
        • Schnettler R.
        Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint.
        J Bone Joint Surg Am. 2003; 85: 185-192
        • Lysholm J.
        • Gillquist J.
        Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.
        Am J Sports Med. 1982; 10: 150-154
        • Tegner Y.
        • Lysholm J.
        Rating systems in the evaluation of knee ligament injuries.
        Clin Orthop. 1985; 198: 43-49
        • Blevins F.T.
        • Steadman J.R.
        • Rodrigo J.J.
        • Silliman J.
        Treatment of articular cartilage defects in athletes.
        Orthopedics. 1998; 21: 761-767
        • Dzioba R.B.
        The classification and treatment of acute articular cartilage lesions.
        Arthroscopy. 1988; 4: 72-80
        • Levy A.S.
        • Lohnes J.
        • Sculley S.
        • LeCroy M.
        • Garrett W.
        Chondral delamination of the knee in soccer players.
        Am J Sports Med. 1996; 24: 634-639
        • Buckwalter J.A.
        • Rosenberg L.C.
        • Coutts R.
        • et al.
        Articular cartilage.
        in: Woo S.L.Y. Buckwalter J.A. The American Academy of Orthopaedic Surgeons Symposium on injury and repair of the musculoskeletal soft tissues. The American Academy of Orthopaedic Surgeons, Park Ridge, IL1988: 465-482
        • Mandelbaum B.R.
        • Browne J.E.
        • Fu F.
        • et al.
        Articular cartilage lesions of the knee.
        Am J Sports Med. 1998; 26: 853-861
        • Jackson D.W.
        • Lalor P.A.
        • Aberman H.M.
        • Simon T.M.
        Spontaneous repair of full-thickness defects of articular cartilage in a goat model.
        J Bone Joint Surg Am. 2001; 83: 53-64
        • Hangody L.
        • Kish G.
        • Karpati Z.
        • Udvarhelyl I.
        • Szigeti I.
        • Bely M.
        Mosaicplasty for the treatment of articular cartilage defects.
        Orthopedics. 1998; 21: 751-756
        • Bauer M.
        • Jackson R.W.
        Chondral lesions of the femoral condyles.
        Arthroscopy. 1988; 4: 97-102
        • Hopkinson W.J.
        • Mitchell W.A.
        • Curl W.W.
        Chondral fractures of the knee.
        Am J Sports Med. 1985; 13: 309-312
        • Zamber R.W.
        • Teitz C.C.
        • McGuire D.A.
        • et al.
        Articular cartilage lesions of the knee.
        Arthroscopy. 1989; 5: 258-268