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Chondral Resurfacing of Articular Cartilage Defects in the Knee with the Microfracture Technique

Surgical Technique

¹ Harvard Vanguard Orthopaedics and Sports Medicine, Brigham and Women's Hospital, 291 Independence Drive, Chestnut Hill, MA 02467. E-mail address: kmithoefer{at}partners.org
² Institute for Cartilage Repair, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

Investigation performed at the Institute for Cartilage Repair, Hospital for Special Surgery, New York, NY

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 87-A, pp. 1911-1920, September 2005

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The line drawings in this article are the work of Joanne Haderer Müller of Haderer & Müller (biomedart{at}haderermuller.com).

Microfracture is a frequently used technique for the repair of articular cartilage lesions of the knee. Despite the popularity of the technique, prospective information about the clinical results after microfracture is still limited. The purpose of our study was to identify the factors that affect the clinical outcome from this cartilage repair technique.

METHODS:

Forty-eight symptomatic patients with isolated full-thickness articular cartilage defects of the femur in a stable knee were treated with the microfracture technique. Prospective evaluation of patient outcome was performed for a minimum follow-up of twenty-four months with a combination of validated outcome scores, subjective clinical rating, and cartilage-sensitive magnetic resonance imaging.

RESULTS:

At the time of the latest follow-up, knee function was rated good to excellent for thirty-two patients (67%), fair for twelve patients (25%), and poor for four (8%). Significant increases in the activities of daily living scores, International Knee Documentation Committee scores, and the physical component score of the Short Form-36 were demonstrated after microfracture (p < 0.05). A lower body-mass index correlated with higher scores for the activities of daily living and SF-36 physical component, with the worst results for patients with a body-mass index of >30 kg/m². Significant improvement in the activities of daily living score was more frequent with a preoperative duration of symptoms of less than twelve months (p < 0.05). Magnetic resonance imaging in twenty-four knees demonstrated good repair-tissue fill in the defect in thirteen patients (54%), moderate fill in seven (29%), and poor fill in four patients (17%). The fill grade correlated with the knee function scores. All knees with good fill demonstrated improved knee function, whereas poor fill grade was associated with limited improvement and decreasing functional scores after twenty-four months.

CONCLUSIONS:

Microfracture repair of articular cartilage lesions in the knee results in significant functional improvement at a minimum follow-up of two years. The best short-term results are observed with good fill grade, low body-mass index, and a short duration of preoperative symptoms. A high body-mass index adversely affects short-term outcome, and a poor fill grade is associated with limited short-term durability.

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This article has been cited by other articles:

				K. Mithoefer, T. McAdams, R. J. Williams, P. C. Kreuz, and B. R. Mandelbaum Clinical Efficacy of the Microfracture Technique for Articular Cartilage Repair in the Knee: An Evidence-Based Systematic Analysis Am. J. Sports Med., October 1, 2009; 37(10): 2053 - 2063. [Abstract] [Full Text] [PDF]

				K. Hambly and K. Griva IKDC or KOOS? Which Measures Symptoms and Disabilities Most Important to Postoperative Articular Cartilage Repair Patients? Am. J. Sports Med., September 1, 2008; 36(9): 1695 - 1704. [Abstract] [Full Text] [PDF]

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