Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-02-2013 | Knee

Reoperative characteristics after microfracture of knee cartilage lesions in 454 patients

Authors: G. M. Salzmann, B. Sah, N. P. Südkamp, P. Niemeyer

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2013

Abstract

Purpose

There is only limited information on those patients who fail following microfracture treatment at the knee joint. Evaluation was made of factors associated with treatment failure and clinical outcome assessment among this collective.

Methods

The study included a total of 560 patients who had previously undergone microfracture for the treatment of symptomatic knee joint cartilage lesions. For the remainder of this study, inclusion criteria were patients that underwent reoperation at the initially operated knee joint (index knee) due to symptoms related to the primary site of microfracture intervention (failure patients) with a minimum postoperative follow-up of 2 years. The remaining cohort of patients served as internal control (non-failure patients). Chart reviews were performed to identify patient and defect characteristics. Patients were evaluated for postoperative Lysholm knee scores, Tegner activity scale, as well as preoperative and postoperative numeric analogue scales (NAS) for function and pain (10 = highest possible function, no pain).

Results

A total of 454/560 (81.1 %) subjects were completely evaluated. Overall, 123/454 patients (26.9 %) (age at operation 43.9 ± 14.1 years, 56 female, BMI 25.8 ± 3.6, 30 smokers, 61.1 ± 68.3 month symptom duration, postoperative follow-up 5.0 ± 2.1) met the inclusion criteria. The postoperative Lysholm score was 63.0 ± 24.6 and the Tegner score was 4.0; NAS function improved from 2.8 ± 1.8 to 4.8 ± 2.2 (P < 0.001), and NAS pain improved from 3.2 ± 2.1 to 5.0 ± 2.4 (P < 0.001). Exclusively, the overall defect size/knee joint was smaller (P = 0.006), postoperative follow-up was longer (P = 0.002), and existense of previous surgery (77.2 vs. 51.6 %, P < 0.001) was more frequent in failure subjects when comparing to non-failure patients (n = 331). The overall clinical outcome among failure subjects was significantly worse when comparing to non-failure subjects. Regression analysis identified that lower preoperative NAS values, being a smoker, and patello-femoral lesions were associated with a higher probability of reoperation.

Conclusion

Within the collective presented here, microfracturing was associated with a high frequency of reoperation. Clinical outcome is worse when compared with that of patients without reoperation. Specific parameters can be identified that increase the eventuality of failure following microfracture treatment.

Level of evidence

IV.

Basad E, Ishaque B, Bachmann G, Sturz H, Steinmeyer J (2010) 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 18(4):519–527PubMedCrossRef

Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85-A(Suppl 2):58–69PubMed

Cole BJ, Pascual-Garrido C, Grumet RC (2009) Surgical management of articular cartilage defects in the knee. J Bone Joint Surg Am 91(7):1778–1790PubMed

Gobbi A, Nunag P, Malinowski K (2005) Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc 13(3):213–221PubMedCrossRef

Gomoll AH, Farr J, Gillogly SD, Kercher J, Minas T (2010) Surgical management of articular cartilage defects of the knee. J Bone Joint Surg Am 92(14):2470–2490PubMed

Gudas R, Kalesinskas RJ, Kimtys V, Stankevicius E, Toliusis V, Bernotavicius G, Smailys A (2005) 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 21(9):1066–1075PubMedCrossRef

Harris JD, Cavo M, Brophy R, Siston R, Flanigan D (2011) Biological knee reconstruction: a systematic review of combined meniscal allograft transplantation and cartilage repair or restoration. Arthroscopy 27(3):409–418PubMedCrossRef

Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 89(10):2105–2112PubMedCrossRef

Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grontvedt T, Solheim E, Strand T, Roberts S, Isaksen V, Johansen O (2004) Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 86-A(3):455–464PubMed

10.

Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M (2009) 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 37(1):33–41PubMedCrossRef

11.

Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, Ghanem N, Uhl M, Sudkamp N (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22(11):1180–1186PubMedCrossRef

12.

Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10(3):150–154PubMedCrossRef

13.

Marder RA, Hopkins G Jr, Timmerman LA (2005) Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy 21(2):152–158PubMedCrossRef

14.

Miller BS, Steadman JR, Briggs KK, Rodrigo JJ, Rodkey WG (2004) Patient satisfaction and outcome after microfracture of the degenerative knee. J Knee Surg 17(1):13–17PubMed

15.

Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR (2009) Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 37(10):2053–2063PubMedCrossRef

16.

Mithoefer K, Williams RJ, Warren RF 3rd, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 8(9):1911–1920CrossRef

17.

Mithoefer K, Williams RJ 3rd, Warren RF, Wickiewicz TL, Marx RG (2006) High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med 34(9):1413–1418PubMedCrossRef

18.

Niemeyer P, Koestler W, Sudkamp NP (2010) Problems and complications of surgical techniques for treatment of full-thickness cartilage defects. Z Orthop Unfall 149(1):45–51PubMed

19.

Niemeyer P, Pestka JM, Kreuz PC, Erggelet C, Schmal H, Suedkamp NP, Steinwachs M (2008) Characteristic complications after autologous chondrocyte implantation for cartilage defects of the knee joint. Am J Sports Med 36(11):2091–2099PubMedCrossRef

20.

Oneto JM, Ellermann J, LaPrade RF (2010) Longitudinal evaluation of cartilage repair tissue after microfracture using T2-mapping: a case report with arthroscopic and MRI correlation. Knee Surg Sports Traumatol Arthrosc 18(11):1545–1550PubMedCrossRef

21.

Reigstad O, Grimsgaard C (2006) Complications in knee arthroscopy. Knee Surg Sports Traumatol Arthrosc 14(5):473–477PubMedCrossRef

22.

Saris DB, Vanlauwe J, Victor J, Almqvist KF, Verdonk R, Bellemans J, Luyten FP (2009) 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 37(Suppl 1):10S–19SPubMedCrossRef

23.

Saris DB, Vanlauwe J, Victor J, Haspl M, Bohnsack M, Fortems Y, Vandekerckhove B, Almqvist KF, Claes T, Handelberg F, Lagae K, van der Bauwhede J, Vandenneucker H, Yang KG, Jelic M, Verdonk R, Veulemans N, Bellemans J, Luyten FP (2008) 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 36(2):235–246PubMedCrossRef

24.

Sherman OH, Fox JM, Snyder SJ, Del Pizzo W, Friedman MJ, Ferkel RD, Lawley MJ (1986) Arthroscopy—“no-problem surgery”. An analysis of complications in two thousand six hundred and forty cases. J Bone Joint Surg Am 68(2):256–265PubMed

25.

Solheim E, Oyen J, Hegna J, Austgulen OK, Harlem T, Strand T (2010) Microfracture treatment of single or multiple articular cartilage defects of the knee: a 5-year median follow-up of 110 patients. Knee Surg Sports Traumatol Arthrosc 18(4):504–508PubMedCrossRef

26.

Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19(5):477–484PubMedCrossRef

27.

Steadman JR, Ramappa AJ, Maxwell RB, Briggs KK (2007) An arthroscopic treatment regimen for osteoarthritis of the knee. Arthroscopy 23(9):948–955PubMedCrossRef

28.

Steadman JR, Rodkey WG, Rodrigo JJ (2001) Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res (391 Suppl):S362–S369

29.

Steadman JRRW, Singleton SB, Briggs KK (1997) Microfracture technique for full-thickness chondral defects: technique and clinical results. Oper Tech Orthop 7:300–304CrossRef

30.

Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMed

31.

van den Borne MP, Raijmakers NJ, Vanlauwe J, Victor J, de Jong SN, Bellemans J, Saris DB (2007) International Cartilage Repair Society (ICRS) and Oswestry macroscopic cartilage evaluation scores validated for use in Autologous Chondrocyte Implantation (ACI) and microfracture. Osteoarthritis Cartilage 15(12):1397–1402PubMedCrossRef

32.

Vasiliadis HS, Lindahl A, Georgoulis AD, Peterson L (2011) Malalignment and cartilage lesions in the patellofemoral joint treated with autologous chondrocyte implantation. Knee Surg Sports Traumatol Arthrosc 19(3):452–457PubMedCrossRef

Title: Reoperative characteristics after microfracture of knee cartilage lesions in 454 patients
Authors: G. M. Salzmann
B. Sah
N. P. Südkamp
P. Niemeyer
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-012-1973-y

At a glance: The STEP trials

Springer Medicine

Reoperative characteristics after microfracture of knee cartilage lesions in 454 patients

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 2/2013

Diagnosis and prognosis of acute hamstring injuries in athletes

Specific injuries induced by the practice of trampoline, tumbling and acrobatic gymnastics

Reconstruction of posterior glenoid deficiency using distal tibial osteoarticular allograft

Non-surgical treatment for acute patellar dislocation with special emphasis on the MPFL injury patterns

Open versus arthroscopic surgical treatment of chronic proximal patellar tendinopathy. A systematic review

Patella instability: building bridges across the ocean a historic review