MONTREAL — Microfracture is a viable and effective way to treat small chondral defects in patients who are athletically active, but improvement declines over time and competitive athletes should be advised as such.
Those were the findings that Alberto Gobbi, MD, presented here at the International Cartilage Repair Society World Congress 2012.
“We found better results in young, active athletes with a short duration of symptoms, small size … and fewer prior surgical interventions,” Gobbi said. “In our study, those who did not do well were those with large chondral defects, lesions to the trochlea or the patella, and multiple lesions. We did find that early failures were seen within 2 years to 3 years of follow-up.”
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Gobbi’s team looked at 170 athletic patients with at least 10 years of follow-up data who underwent microfracture procedures between 1991 and 2001. In all, 53 patients met all the inclusion criteria, which included self-administered questionnaires, preoperative and postoperative International Knee Documentation Committee scores, Lysholm scores and Tegner scores.
Following 10 years to 15 years of follow-up, Gobbi and colleagues found patients who underwent microfracture to treat full-thickness chondral defects with of a size greater than 3 cm² tended to fail within 1 year. The group also required another surgery.
Patients who underwent the procedure for lesions smaller than 2.5 cm² demonstrated significant functional improvements for the first 5 postoperative years. After that, however, the results gradually deteriorated because of reduced activity levels.
While these athletes had lower activity levels, they also demonstrated significant improvement in pain and function, Gobbi noted.
Microfracture appeared functionally successful, however there were factors to keep in mind, Gobbi said.
“We found functionally subjective improvements with microfracture, however, we found a decline in the level of sport activity with time,” he said. “Microfracture may not be a definitive treatment in the young athlete’s knee, especially if the athlete has large or multiple lesions.”
In older patients, “microfracture can relieve symptoms and may delay arthroplasty,” he added.
- Gobbi A, Kumar A, Karnatzikos G. Microfracture treatment in athletes with knee grade IV chondral lesions: A 10-year follow up. Paper #16.3.5. Presented at the International Cartilage Repair Society World Congress 2012. May 12-15. Montreal.
- Disclosure: Gobbi has no relevant financial disclosures.