Abstract
This prospective outcomes study was designed to prospectively investigate the outcome of the microfracture technique when applied to full thickness chondral lesions of the knee in a group of athletes. From 1991 to 1999, 109 patients were treated using the microfracture technique. We prospectively followed up 53 athletes who satisfied our inclusion criteria. Average age was 38 years (range 19–55) and mean follow-up was 72 months (range 36–120). Etiology, clinical signs, symptoms and activity level were noted preoperatively and at final follow-up. Lysholm, Tegner, IKDC and functional tests were utilized. Intraoperatively, location, size of the lesions and associated pathologies were recorded. Roentgenograms, MRI or CT scan were done before treatment and at final follow-up. Etiologic factors were mostly related to sports microtrauma (37.5%) and macrotrauma (21%), while 37.5% of our patients did not report any traumatic etiology and 4% showed patellar malalignment. The most common location was medial femoral condyle (61%). Knee pain and swelling improved in 70%, tibiofemoral crepitus in 60%. Hop test was normal in 70% at final follow-up. Subjective evaluation was 40/100 preoperatively and 70/100 at final follow-up. Lysholm was 56.8 preoperatively and 87.2 final. IKDC revealed: 0 A, 3 B, 40 C and 10 D preoperatively while at final follow-up 70% scored A or B. Tegner improved at 2 years from 3.2 to 6; however, at final follow-up 80% showed a decline in sport activity level (Tegner 5). Microfracture technique can offer clinical, functional and subjective improvement in athletically active patients. However because of the decline in sports participation over time, microfracture may not be the definitive procedure for the athlete’s knee and other procedures may be indicated in the future.
Similar content being viewed by others
References
Alfredson H, Lorentzon R (1999) Superior results with continuous passive motion compared to active motion after periostal transplantation. Knee Surg Sports Traumatol Arthrosc 7:232–238
Alfredson H, Thorsen K, Lorentzon R (1999) Treatment of tear of the anterior cruciate ligament combined with localised deep cartilage defects in the knee with ligament reconstruction and autologous periosteum transplantation. Knee Surg Sports Traumatol Arthrosc 7:69–74
Blevins FT, Steadman J, Rodrigo JJ et al (1998) Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. Orthopaedics 21:767–768
Browne JE, Branch TP (2000) Surgical alternatives for articular cartilage lesions. J Am Acad Orthop Surg 8:180–189
Cain EL, Clancy WG (2001) Treatment algorithm for osteochondral injuries of the knee. Clin Sports Med 20:321–342
Curl WW, Krome J, Gordon S et al (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13:456–460
Frisbie D, Oxford J, Southwood L, Trotter G et al (2003) Early events in cartilage repair after subchondral bone microfracture. Clin Orthop 407:215–227
Ghadially FN, Thomas I, Oryschak AF et al (1997) Long-term results of superficial defects in articular cartilage: a scanning electron microscope study. J Pathol 121:213–217
Gilbert J (1998) Current treatment options for the restoration of the articular cartilage. Am J Knee Surg 11:42–46
Gill TJ, Steadman JR, Briggs KK et al (1999) The treatment of full-thickness chondral defects in the knee: indications, techniques and long term results of microfracture. Presented at annual meeting of AAOS, Anaheim, Calif
Grana WA (2000) Healing of articular cartilage: a review. Am J Knee Surg 13:29–32
Harwin SF (1999) Arthroscopic debridement for osteoarthritis of the knee: predictor of patient satisfaction. Arthroscopy 15:142–146
Hoemann C, Hurtig M, Ranger P et al (2003) Full-thickness cartilage repair using an injectable chitosan scaffold, BST-Cargel. Presented at 7th International Orthopaedics, Biomechanics, Sports Rehabilitation Conference, Assisi
Hunziker EB (2002) Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects. Osteoarthritis Cartilage 10:432–463
Jun-kyo S, Scherping S, Takashi M et al (1995) Basic science of articular cartilage injury and repair. Oper Tech Sports Med 3:78–86
Knutsen G, Engebretsen L, Ludvigsen T et al (2003) A randomized trial of chondrocyte implantation versus microfracture in the knee. Presented at 7th International Orthopaedics, Biomechanics, Sports Rehabilitation Conference, Assisi
Lorentzon R, Alfredson H, Hildingsson C (1998) Treatment of deep cartilage defects of patella with periostal transplantation. Knee Surg Sports Traumatol Arthrosc 6:202–208
Marder A, Timmerman LA (2003) Athroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Presented at the Annual meeting Arthroscopy Association of North America, Phoenix, Ariz
Minas T, Nehrer S (1997) Review: current concepts in the treatment of articular cartilage defects. Orthopedics 20:525–538
Mosely JB, Anderson A, Browne JE (2003) A controlled study of autologous chondrocyte implantation versus microfracture for articular cartilage lesions of the femur. Arthoscopy Association of North America meeting, Phoenix, Ariz
Newman A (1998) Articular cartilage repair. Am J Sports Med 26:309–324
Ochi M (2003) Transplantation of tissue-engineered cartilage for repair of cartilage defects. Presented at 7th International Orthopaedics, Biomechanics, Sports Rehabilitation Conference, Assisi
O’Driscoll S (1998) Current concepts review: the healing and regeneration of articular cartilage. J Bone Joint Surg Am 80:1795–1812
Rae PJ, Noble J (1998) Arthroscopic drilling of osteochondral lesions of the knee. J Bone Joint Surg Br 71:534
Rodkey WG, Steadman JR, Rodrigo JJ et al (1999) The microfracture technique to treat full thickness articular cartilage defects: biological basis and long term clinical results. In: AANA Annual Meeting Instructional Course lecture #105 “Arthroscopic treatment of chondral injuries: Options and techniques”
Rodrigo JJ, Steadman JR, Silliman JF, Fulstone HA (1994) Improvement of full thickness chondral defect healing in the human knee after debridement and microfracture using continuous passive motion. Am J Knee Surg 7:109–116
Shapiro F, Koide S, Glimcher MJ (1993) Cell origin and differentiation in the repair of full thickness defects of articular cartilage. J Bone Joint Surg Am 75:532–553
Sledge SL (2001) Microfracture techniques in the treatment of osteochondral injuries. Clin Sports Med 20:365–377
Steadman JR, Rodkey W, Rodrigo J (2001) Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop 391S:362–369
Steadman JR, Miller BS, Briggs KK, Rodkey WG (2002) Patient satisfaction and functional outcome after microfracture of the degenerative knee. Presented at the 4th International Cartilage Repair Society Symposium, Toronto
Xiaochun Wei (2002) Cartilage defects treated with periostal transplantation and drilling of subchondral bone. Presented at the 4th International Cartilage Repair Society Symposium, Toronto
Yoon KH, Kim HS, Lim CT, Bae DK (2003) Cartilage regeneration after microfracture in osteoarthritic knee. In: American Academy of Orthopedic Surgeons Meeting, New Orleans
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gobbi, A., Nunag, P. & Malinowski, K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc 13, 213–221 (2005). https://doi.org/10.1007/s00167-004-0499-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-004-0499-3