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Microfracture for cartilage repair in the knee: a systematic review of the contemporary literature

  • Patrick Orth
  • Liang Gao
  • Henning MadryEmail author
KNEE
  • 115 Downloads

Abstract

Purpose

To systematically review and evaluate novel clinical data following microfracture treatment of knee articular cartilage defects.

Methods

A systematic review was performed by searching PubMed, ScienceDirect, and Cochrane Library databases for clinical trials on microfracture treatment, published between 2013 and 2018. Titles, abstracts, and articles were reviewed, and data concerning patient demographics, study design, pre-, intra-, and postoperative findings were extracted. PRISMA guidelines were applied. The methodological quality of the included studies was analyzed by the modified Coleman Methodology Score (CMS), and aggregate data were generated.

Results

Eighteen studies including 1830 defects (1759 patients) were included. Of them, 8 (59% of patients) were cohort studies without a comparison group. Overall study quality was moderate (mean total CMS: 64 points), mainly due to low patient numbers, short follow-up periods, lack of control groups and structural repair tissue evaluation, and inhomogeneity in outcome parameters. Microfracture treatment of full-thickness articular cartilage defects (3.4 ± 2.1 cm2) was performed at 43.4 ± 68.0 months of symptom duration. Postoperative assessment at 79.5 ± 27.2 months revealed failure rates of 11–27% within 5 years and 6–32% at 10 years. Imaging analysis was conducted in 10 studies, second-look arthroscopies were reported twice (n = 205 patients) and revealed well integrated fibrocartilaginous repair tissue.

Conclusions

Microfracture provides good function and pain relief at the mid-term and clinically largely satisfying results thereafter. Standardized, high-quality future study designs will better refine optimal indications for microfracture in the context of cartilage repair strategies.

Level of evidence

This systematic review is based on studies with levels of evidence ranging between I and IV (see results section and Table). Therefore, and according to this journals Instructions for Authors (SYSTEMATIC REVIEWS AND META-ANALYSES are assigned a level of evidence equivalent to the lowest level of evidence used from the manuscripts analysed), level of evidence is IV.

Keywords

Marrow stimulation Microfracture Articular cartilage Subchondral bone 

Notes

Funding

Funding information not available (no funding was received).

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

Ethical approval statement not applicable.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

167_2019_5359_MOESM1_ESM.doc (6.3 mb)
Supplementary material 1 (DOC 6477 KB)
167_2019_5359_MOESM2_ESM.tif (8.5 mb)
Supplementary material 2 (TIF 8697 KB)

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Center of Experimental OrthopaedicsSaarland UniversityHomburgGermany
  2. 2.Department of Orthopaedic SurgerySaarland University Medical CenterHomburgGermany

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