Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee: a prospective randomized trial with long-term follow-up

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Abstract

Purpose

To compare long-term functional and radiological outcome following microfracture technique (MF) versus osteochondral autologous transplantation (OAT) mosaicplasty for treating focal chondral lesions of the knee.

Methods

Twenty-five patients (mean age 32.3 years, SD 7.7) with a full-thickness (International Cartilage Repair Society grade 3 or 4) chondral lesion of the articulating surface of the femur were randomized to either MF ( n = 11) or OAT mosaicplasty ( n = 14). At a median follow-up of 9.8 years (range 4.9–11.4), the patients were evaluated using Lysholm score ( n = 25), Knee Injury and Osteoarthritis Outcome Score (KOOS, n = 25), isokinetic quadriceps measurement and hamstring strength measurement ( n = 22) and standing radiographs ( n = 23).

Results

There were no significant differences in Lysholm score, KOOS, isokinetic muscle strength or radiographic osteoarthritis between MF-treated patients and OAT mosaicplasty-treated patients at follow-up. Mean Lysholm score at follow-up was 69.7 [95 % confidence interval (CI), 55.1–84.4] for the MF group and 62.6 (95 % CI, 52.6–72.6) for the OAT mosaicplasty group.

Conclusion

At long-term follow-up, there were no significant differences between patients treated with MF and patients treated with OAT mosaicplasty in patient-reported outcomes, muscle strength or radiological outcome.

Level of evidence

Therapeutic study, Level II.

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Most cited references 32

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Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up.

J. Richard Steadman, Karen Briggs, Juan Rodrigo … (2003)

In this study, we measured functional outcomes of patients treated arthroscopically with microfracture for full-thickness traumatic defects of the knee. A case series of patients with 7 to 17 years' follow-up. Between 1981 and 1991, a total of 72 patients (75 knees) met the following inclusion criteria: (1) traumatic full-thickness chondral defect, (2) no meniscus or ligament injury, and (3) age 45 years and younger (range, 13 to 45 years). Seventy-one knees (95%) were available for final follow-up (range, 7 to 17 years). All patients completed self-administered questionnaires preoperatively and postoperatively. The following results were significant at the P <.05 level. Significant improvement was recorded for both Lysholm (scale 1 to 100; preoperative, 59; final follow-up, 89) and Tegner (1 to 10; preoperative, 3; final follow-up, 6) scores. At final follow-up, the SF-36 and WOMAC scores showed good to excellent results. At 7 years after surgery, 80% of the patients rated themselves as "improved." Multivariate analysis revealed that age was a predictor of functional improvement. Over the 7- to 17-year follow-up period (average, 11.3 years), patients 45 years and younger who underwent the microfracture procedure for full-thickness chondral defects, without associated meniscus or ligament pathology, showed statistically significant improvement in function and indicated that they had less pain.

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Articular cartilage defects in 1,000 knee arthroscopies.

Karin Hjelle, Eirik Solheim, Torbjørn Strand … (2002)

Focal chondral or osteochondral defects can be painful and disabling, have a poor capacity for repair, and may predispose patients for osteoarthritis. New surgical procedures that aim to reestablish hyaline cartilage have been introduced and the results seem promising. The purpose of this study is to provide reliable data on chondral and osteochondral defects in patients with symptomatic knees requiring arthroscopy and to calculate the prevalence of patients who might benefit from cartilage repair surgery. Prospective study. One thousand consecutive knee arthroscopies were included in this study. Immediately after each arthroscopy, the surgeon completed a questionnaire providing detailed information about the findings. Chondral and osteochondral lesions were classified in accordance with the system recommended by the International Cartilage Repair Society (ICRS). Chondral or osteochondral lesions (of any type) were found in 61% of the patients. Focal chondral or osteochondral defects were found in 19% of the patients. In these patients, 61% related their current knee problem to a previous trauma, and a concomitant meniscal or anterior cruciate ligament injury was found in 42% (n = 81) and 26% (n = 50), respectively. The mean chondral or osteochondral total defect area was 2.1 cm(2) (range, 0.5 to 12; standard deviation [SD], 1.5). The main focal chondral or osteochondral defect was found on the medial femoral condyle in 58%, patella in 11%, lateral tibia in 11%, lateral femoral condyle in 9%, trochlea in 6%, and medial tibia in 5%. It has been suggested that cartilage repair surgery may be most suitable in patients younger than 40 to 50 years old. A single, well-defined ICRS grade III or IV defect with an area of at least 1 cm(2) in a patient younger than 40, 45, or 50 years accounted for 5.3%, 6.1%, and 7.1% of all arthroscopies, respectively. Our study supports the contention that articular cartilage defects are common. It has the advantages of a prospective design and use of a new classification system recommended by the ICRS. This modern system focuses on objectively measurable parameters of the lesion's extent and not its surface appearance.

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Generation of allocation sequences in randomised trials: chance, not choice.

Kenneth F Schulz, David A Grimes (2002)

The randomised controlled trial sets the gold standard of clinical research. However, randomisation persists as perhaps the least-understood aspect of a trial. Moreover, anything short of proper randomisation courts selection and confounding biases. Researchers should spurn all systematic, non-random methods of allocation. Trial participants should be assigned to comparison groups based on a random process. Simple (unrestricted) randomisation, analogous to repeated fair coin-tossing, is the most basic of sequence generation approaches. Furthermore, no other approach, irrespective of its complexity and sophistication, surpasses simple randomisation for prevention of bias. Investigators should, therefore, use this method more often than they do, and readers should expect and accept disparities in group sizes. Several other complicated restricted randomisation procedures limit the likelihood of undesirable sample size imbalances in the intervention groups. The most frequently used restricted sequence generation procedure is blocked randomisation. If this method is used, investigators should randomly vary the block sizes and use larger block sizes, particularly in an unblinded trial. Other restricted procedures, such as urn randomisation, combine beneficial attributes of simple and restricted randomisation by preserving most of the unpredictability while achieving some balance. The effectiveness of stratified randomisation depends on use of a restricted randomisation approach to balance the allocation sequences for each stratum. Generation of a proper randomisation sequence takes little time and effort but affords big rewards in scientific accuracy and credibility. Investigators should devote appropriate resources to the generation of properly randomised trials and reporting their methods clearly.

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Author and article information

Contributors

Svend Ulstein: +47-97-606222 , svend.ulstein@ahus.no

Journal

Journal ID (nlm-ta): Knee Surg Sports Traumatol Arthrosc

Journal ID (iso-abbrev): Knee Surg Sports Traumatol Arthrosc

Title: Knee Surgery, Sports Traumatology, Arthroscopy

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0942-2056

ISSN (Electronic): 1433-7347

Publication date (Electronic): 21 January 2014

Publication date PMC-release: 21 January 2014

Publication date (Print): 2014

Volume: 22

Pages: 1207-1215

Affiliations

[ ]Department of Orthopedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway

[ ]Oslo Sports Trauma Research Center, Oslo, Norway

[ ]Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Lørenskog, Norway

[ ]Department of Orthopaedics, Oslo University Hospital, Oslo, Norway

[ ]Norwegian Knee Ligament Registry, Bergen, Norway

[ ]Department of Orthopaedic Surgery, Martina Hansens Hospital, Bærum, Norway

Article

Publisher ID: 2843

DOI: 10.1007/s00167-014-2843-6

PMC ID: 4028546

PubMed ID: 24441734

SO-VID: 4933bb4c-50af-48ae-81e7-bcd87638cb97

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

History

Date received : 25 June 2013

Date accepted : 9 January 2014

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: chondral lesion,microfracture,mosaicplasty,long-term follow-up,lysholm,koos

Data availability:

ScienceOpen disciplines: Surgery

Keywords: chondral lesion, microfracture, mosaicplasty, long-term follow-up, lysholm, koos

Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee: a prospective randomized trial with long-term follow-up

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Most cited references 32

Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up.

Articular cartilage defects in 1,000 knee arthroscopies.

Generation of allocation sequences in randomised trials: chance, not choice.

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