Purpose
Although many newer cartilage repair techniques have evolved over the past 2 decades,
microfracture is still being advocated as the first line of treatment. Therefore it
is timely to conduct a comprehensive review of the literature to assess and report
on the current status of Level I and II evidence studies related to microfracture
techniques.
Methods
A literature search was carried out for Level I and II evidence studies on cartilage
repair using the PubMed database. All the studies that dealt with microfracture techniques
were selected.
Results
Fifteen studies that involved microfracture techniques met the inclusion criteria
of this review article, with 6 long-term and 9 short-term studies. These studies compared
the clinical outcomes of microfracture with those of other treatments such as autologous
chondrocyte implantation and osteochondral cylinder transfers. The majority of the
studies reported poor clinical outcomes, whereas 2 studies reported the absence of
any significant difference in the results. Small-sized lesions and younger patients
showed good results in the short-term. However, osteoarthritis and treatment failures
were observed at later postoperative periods of 5 to 10 years.
Conclusions
The use of microfracture for the treatment of small lesions in patients with low postoperative
demands was observed to result in good clinical outcomes at short-term follow-up.
Beyond 5 years postoperatively, treatment failure after microfracture could be expected
regardless of lesion size. Younger patients showed better clinical outcomes.
Level of Evidence
Level II, systematic review of Level I and II studies.
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 accessOne-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 ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.N Engl J Med. 1994; 331: 889-895
- Of the structure and diseases of articulating cartilages, by William Hunter, surgeon.Philos Trans R Soc Lond. 1742; 42: 514-521
- Microfracture: Surgical technique and rehabilitation to treat chondral defects.Clin Orthop Relat Res. 2001; 391: S362-S369
- Treatment of articular cartilage defects in athletes: An analysis of functional outcome and lesion appearance.Orthopedics. 1998; 21 (discussion 767-768): 761-767
- Treatment of focal articular cartilage defects in the knee: A systematic review.Clin Orthop Relat Res. 2008; 466: 952-962
- Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: A prospective, randomised study.J Bone Joint Surg Br. 2005; 87: 640-645
- Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: A 2-year randomised study.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 519-527
- A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee.J Bone Joint Surg Br. 2003; 85: 223-230
- Comparative evaluation of autologous chondrocyte implantation and mosaicplasty: A multicentered randomized clinical trial.Clin J Sport Med. 2005; 15: 220-226
- A randomized trial comparing accelerated and traditional approaches to postoperative weightbearing rehabilitation after matrix-induced autologous chondrocyte implantation: Findings at 5 years.Am J Sports Med. 2012; 40: 1527-1537
- Osteochondral lesions of the talus: Randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation.Arthroscopy. 2006; 22: 1085-1092
- A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: Periosteum covered versus type I/III collagen covered.Knee. 2006; 13: 203-210
- Comparison of osteochondral autologous transplantation, microfracture, or debridement techniques in articular cartilage lesions associated with anterior cruciate ligament injury: A prospective study with a 3-year follow-up.Arthroscopy. 2013; 29: 89-97
- Ten-year follow-up of a prospective, randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint of athletes.Am J Sports Med. 2012; 40: 2499-2508
- A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes.Arthroscopy. 2005; 21: 1066-1075
- A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children.J Pediatr Orthop. 2009; 29: 741-748
- Osteochondral autologous transplantation versus microfracture for the treatment of articular cartilage defects in the knee joint in athletes.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 834-842
- Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial.J Bone Joint Surg Am. 2003; 85: 185-192
- A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years.J Bone Joint Surg Am. 2007; 89: 2105-2112
- Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial.J Bone Joint Surg Am. 2004; 86: 455-464
- Articular cartilage treatment in high-level male soccer players: A prospective comparative study of arthroscopic second-generation autologous chondrocyte implantation versus microfracture.Am J Sports Med. 2011; 39: 2549-2557
- Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: Prospective nonrandomized study at 5 years.Am J Sports Med. 2009; 37: 33-41
- Importance of sports in cartilage regeneration after autologous chondrocyte implantation: A prospective study with a 3-year follow-up.Am J Sports Med. 2007; 35: 1261-1268
- Current treatments of isolated articular cartilage lesions of the knee achieve similar outcomes.Clin Orthop Relat Res. 2012; 470: 2261-2267
- Autologous chondrocyte implantation for treatment of focal cartilage defects in patients age 40 years and older: A matched-pair analysis with 2-year follow-up.Am J Sports Med. 2010; 38: 2410-2416
- Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques.Am J Sports Med. 2009; 37: 902-908
- Cost-effectiveness analysis of autologous chondrocyte implantation: A comparison of periosteal patch versus type I/III collagen membrane.Am J Sports Med. 2012; 40: 1252-1258
- Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture.Am J Sports Med. 2008; 36: 235-246
- Treatment of symptomatic cartilage defects of the knee: Characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture.Am J Sports Med. 2009; 37: 10S-19S
- Autologous chondrocyte implantation versus microfracture for knee cartilage injury: A prospective randomized trial, with 2-year follow-up.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 486-495
- Physical activity levels after characterized chondrocyte implantation versus microfracture in the knee and the relationship to objective functional outcome with 2-year follow-up.Am J Sports Med. 2009; 37: 42S-49S
- Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: Early treatment matters.Am J Sports Med. 2011; 39: 2566-2574
- Autologous chondrocyte implantation for the treatment of cartilage lesions of the knee: A systematic review of randomized studies.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1645-1655
- Treatment of deep cartilage defects of the knee using autologous chondrograft transplantation and by abrasive techniques—A randomized controlled study.Acta Chir Belg. 2004; 104: 709-714
- Human autologous culture expanded bone marrow mesenchymal cell transplantation for repair of cartilage defects in osteoarthritic knees.Osteoarthritis Cartilage. 2002; 10: 199-206
- Effect of accelerated weightbearing after matrix-associated autologous chondrocyte implantation on the femoral condyle on radiographic and clinical outcome after 2 years: A prospective, randomized controlled pilot study.Am J Sports Med. 2009; 37: 88S-96S
- A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: Results of the Study of the Treatment of Articular Repair (STAR) clinical trial.Am J Sports Med. 2009; 37: 42-55
- Autologous chondrocyte implantation using the original periosteum-cover technique versus matrix-associated autologous chondrocyte implantation: A randomized clinical trial.Am J Sports Med. 2010; 38: 924-933
Article info
Publication history
Accepted:
May 28,
2013
Received:
January 23,
2013
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
